FORM-I (See Clause 5) APPLICATION FOR ISSUE OF FREE BUS PASS TO MEDIA PERSON IN THE UNION TERRITORY OF PUDUCHERRY IN PONDICHERRY ROAD TRANSPORT CORPORATION BUSES 1. Name of the Applicant : 2. Designation : 3. Name of the Media : 4. Date of Joining in the Media : 5. Whether the Service Certificate is enclosed : 6. Whether the applicant is a Native of U.T. of Puducherry either by virtue of birth or by continuous Residence (Nativity/Residence certificate to be attached) : 7. Address: Present : 8. Address: Permanent : 9. Phone Number : (O) (R) 10. Blood Group : DECLARATION I, ...................... hereby solemnly affirm and declare that the particulars furnished above are true and I have not suppressed any material fact that will disentitle me for the grant under the scheme for the grant of Free Bus Passes to Media Persons in the Union Territory of Puducherry in the Pondicherry Road Transport Corporation (PRTC) Buses -2006 .I also affirm that the bus pass issued to me shall be used only for my bonafide journalistic purposes. Place : Signature of the Applicant Date : FORM - II (See Clause 5) SERVICE CERTIFICATE Certified that Thiru/Selvi/Tmt ........................S/o, D/o, W/o ........................ is working continuously for the period of ...........years from ........... to......... as Full time Editor/Sub-Editor/Reporter/Press Photographer/Correspondent/Cameraman of the Print / Electronic Media / News Agency viz..................... Registered with the Registrar of Newspapers of India/Ministry of Information and Broadcasting, Government of India, New Delhi vide No................... Place: Signature of the employer: Date : Name: Designation: Seal FORM-III (See Clause 8) APPLICATION FOR RENEWAL OF FREE BUS PASS IN THE PONDICHERRY ROAD TRANSPORT CORPORATION BUSES 1. Name of the Applicant : 2. Designation : 3. Name of the Media : 4. Date of Joining in the Media : 5. Whether continuing the service in the same firm (Service Certificate is to be enclosed) : 6. Whether the applicant is a Native of U.T. of Puducherry either by virtue of birth or by continuous Residence (Nativity/Residence certificate to be attached) : 7. Bus Pass .No. & Code Number (Issued by the Government earlier) : 8. Address: Present : 9. Address: Permanent : 10. Phone Number : (O) (R) DECLARATION I, ...................... hereby solemnly affirm and declare that the particulars furnished above are true and I have not suppressed any material fact that will disentitle me for the grant under the scheme for the grant of Free Bus Passes to Media Persons in the Union Territory of Puducherry in the Union Territory of Puducherry in the Pondicherry Road Transport Corporation (PRTC) Buses -2006. I also enclose herewith an attested copy of the original bus pass and I shall return the original bus pass when a new bus pass is issued to me. Place : Signature of the Applicant Date : Residential Address with Telephone / Cell No. Blood Group Signature of the holder Signature of the Director (Info & Pub.) Terms & Conditions 1. The pass should be produced in original to the conductor / Inspecting Authority during the time of travel; 2. The pass is valid for one year from the date of issue and has to be renewed after its expiry to avail the benefit; 3. Incase the pass is lost, it should be reported to the Directorate I m m e d i a t e l y ; . 4. In the event of cancellation / postponement of journeys , the Media Person in good faith should return the ticket to the PRTC counter for cancellation of entries of travel;. 5. The pass would be acceptable in all the buses operated by the PRTC except town buses; 6. The Media Person, while making a reservation for travel has to show the Bus pass for availing the benefit of being issued with a free ticket; 7. The Media Person, has to pay the reservation charges to PRTC. The reservation charges are not refundable by the PRTC nor by the Directorate under any circumstances and should be borne by the Media P e r s o n ; . 8 . T he p ass is no t trans ferab le and an y mis u se o f it i s Punishable; 9. No priority in reservation/allocation of seats in the buses is possible;
