ANDHRA PRADESH STATE ROAD TRANSPORT CORPORATION Application Form for Student Concessional Bus/Pass/ General Bus Ticket/ Physically Handicapped Bus Pass Name of the applicant ............................................ S/O, D/O ........................................... Age ........................... Residential address ................................................................................................................. journey particulars from ........................................To ............................................................... (in case of student Bus Passes Only). I do hereby apply for a student Concessional Bus Pass/ General Bus Ticket/ Physically Handicaped Bus Pass subject to the Rules and Regulations of APSRTC by paying the requisite charges.. I certify that the particulars are true and correct. Signature of Applicant. CERTIFICATE OF THE HEAD OF THE SCHOOL / COLLEGE ( in case of students) I hereby certify that Sri/Kum./Smt ................................................................................ is a bonafide student of ............................... studying in class ............................ His/Her date of birth is ................................................ as per this Office Records. Students Concessional Bus Pass/ General Bus Ticket/ Physically Handicapped Bus Pass may be issued. Admission No. .......................................... Signature of the Head of the School/College with Office Seal. Station .................................... Date ...................................... NOTE : Physically handicapped person shall submit a certificate issued by a Government Medical Officer not below the Rank of Civil Assistant Surgeon, indicating the nature of disability, i.e Blind, Deaf & Dumb or Lane. Date ........................................... (FOR THE USE OF A.P.S.R.T.C. ONLY) (For Student Bus Pass only) Authorised travel : Route No. From PLACE To STAGE NO. From To PARTICULARS OF ISSUE OF IDENTITY CARD / STUDENT CONCESSIONAL BUS PASS / GENERAL BUS TICKET / PHYSICALLY HANDICAPPED BUS PASS Identity Card No................................. Date ....................... Cash Receipt No.................................. Student Bus Pass No............................ Date ...................... Date .................................................... General Bus Pass No. .......................... Date ...................... Physically Handicapped Ticket No.....................Date....................... M.T.D. 418 / R Signature of the Issuing Authority with Office Seal
