BANGALORE METROPOLITAN TRANSPORT CORPORATION

(Students Bus Pass Application)

To be filled in Block letters

Student Name: ………………………………………………………………

SATS No…………………………………………………………………………. Affix a recent

stamp size Photo
DoB:……………………….………… Gender: …………………………….
of the applicant
Category: GM/Other (OBC)/SC/ST………………………………….. with seal & sign of
institution.
Present residential address:……………………………………………..

Door #:………………………… ………….Street:……………………………

Locality:…………………………………….pin code:………………………

Father Name: ……………………………………………………………… … Contact Tel.No: …………………….

Mother Name……………………………………………………………..

Are you staying in Hostel: Yes No:

If yes, Hostel Address ----------------------------

………………………………………………………………………..

Are you staying in residential School: Yes No

Class:…………… Educational Institution:… ………………………… …………

Signature of Parent/Guardian Student’s Signature

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Certificate from Educational Institution

The above information furnished by the student studying in the academic year 2021-22 in our Institution is
true as per our record.

Student’s Registration No: Signature of Head of the

Institution with seal & Date