BANGALORE METROPOLITAN TRANSPORT CORPORATION

(Students Concessional Bus Pass Application)

To be filled in Block letters

Full Name: DoB:.Age: Gender: Present Postal address:. Door #: Street:.. Locality:.pin code:. Name of the Parent/guardian: .

Permanent address... Contact Tel.No: .. . Email Address: . Aadhar No (If available )

Students Requirement : Ordinary pass / Travel as you like pass / Renewal / Extension

Travel Details

Class:.. Educational Institution: From: To: Place of Changeover:.....Distance (in KM).. Validity Period: . . to

Signature of Parent/Guardian Students Signature ---------------------------------------------------------------------------------------------------------------------------

Certificate from Educational Institution

The above information furnished by the student studying in our Educational Institution is true as

per our record.

Students Registration No: Signature of Head of the Institution with seal & Date

---------------------------------------------------------------------------------------------------------------------------

Terms& Conditions

Production of the following document is compulsory :

1) Original fee Receipt for the current academic year.

2) Identity Card issued by the Educational Institution.

3) 2 Photo 4) Copy of the Aadhar Card ( If available please enclose)

Rules to be followed

Pass not transferable to be produced for inspection on demand by BMTC authorities - Rs.100/-+ fee for the balance validity period to be paid for obtaining Duplicate Pass after due Police

formalities in case of loss during the validity period.

Office use only ( To be filled in by the official deployed for scrutinizing pass application)

Total distance travelled by student in KMs ______________

Total stages travelled by Student _______________________

Examined person name & signature

Affix a recent

stamp size

Photo of the

applicant with

seal & sign of

institution