Bmtc Bus Form 5m503q

BANGALORE METROPOLITAN TRANSPORT CORPORATION (Students Concessional Bus Application) To be filled in Block letters Full Name: ……………………………………………………………… Affix a recent DoB:……………………….…………Age:…………………… stamp size Gender: ……………………………… Photo of the Present Postal address:……………………………………………………….…… applicant with Door #:………………………… Street:…………….. seal & sign of Locality:……………………….pin code:……………. institution Name of the Parent/guardian: ……………. Permanent address………………... ………………………………. Tel.No: ……………….. ………………………………. Email Address: ………………… ………………………………. Student’s Requirement : Ordinary / Travel as you like / Renewal / Extension Travel Details Class:…………………….. Educational Institution:………………… From:……………………… To:……………………… Place of Changeover:……………………………………….....Distance (in KM)……………….. Validity Period: ……………. …. to………………… Signature of Parent/Guardian Student’s Signature -------------------------------------------------------------------------------------------------------------------------Certificate from Educational Institution The above information furnished by the student studying in our Educational Institution is true as per our knowledge. Student’s Registration No:

Signature of Head of the Institution with seal & Date

-------------------------------------------------------------------------------------------------------------------------& 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 Rules to be followed 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 after due Police formalities in case of loss during the validity period.