Application for Issuance of Smart Card

Category for which Smart card to be issued: Paste your

duly attested
Personalized Smart Card (e-wallet) Latest Photo
here
Personalized Smart Card (Concessional Pass)

Personalized Smart Card (Concessional Pass with e wallet)

Anonymous Smart Card (e-wallet)

AC Non AC

Station From _____________________ Station To____________________

Duration for which Smart card required:-

Monthly Quarterly Half Year Yearly

Charges for Smart Card: (For Office use only)________

1. Name :_________________________________ Age_____________

2. Father’s Name :___________________________________________

3. Gender : Male Female Others

4. Residential Address :________________________________________

________________________________PIN Code:________________

Mobile Number:________________Email_______________________

5. School/Institute/Department address:___________________________

_________________________________________________________

Authorized Signatory
with Stamp of
School/Institute/Department
Name :
Designation :
Phone No.
Self Declaration:-
I accept all the terms & conditions, rules, regulations required for issuance and to use of
Smart Card in local CTU/CCBSS buses.

Signature of Applicant
Mobile / Telephone No.
___________________

Instruction:-

1. The photo and form both will be attested by the HOD Authorized Signatory of
department/ Institution as the case may be in case of Student /Employee pass. Also
enclose one extra photograph.
2. Senior Citizen may submit this form along with copy of photo ID proof and copy of
senior citizen card issued by Chandigarh Administration.
3. In case of any queries and information kindly visit our web portal
“https://ctuportal.amnex.com”, Mobile app “TrycityBus” or on Toll free
number: “18002747400”.