DELHI TRANSPORT CORPORATION

(Govt. of N.C.T. of Delhi)

Application Form for New Bus Pass (Student Category only)
(To be filled in Capital Letter only)

1 Name of the Applicant

2 Name of Father

D D M M Y Y
3 Date Age: Ph.
of Birth
4 Residential Address: _______________________________________________________________________

_____________________________________________________________ Pin

5 Type of Pass Required (Tick only one) Destination All Route Non-AC All Route AC

6 Information Required for Destination Pass Place From: ___________________ To: __________________

7 Period of Pass Required Date From: ____________________To: __________________

8 Name Address and Code No. of the Educational Code No. Paste Recent
. Institute: Photograph & get it
attested by the
Principal / Head of
(1) Name and Address Institute.

________________________________________________________

(2) Class: Roll No.:

(3) Student Identify Card No.:

(4) State whether Employed or Not

Student’s Signature

It is certified that the columns filled by the student are correct and have been verified from our record
and it will be valid for 5 months. The certificated is valid for two weeks from the date of issue.

Dated: / / Signature of the Principal/Head of the Institute

(Office Stamp with Address)