You can purchase 10ride tickets for 50% of the standard fare at. In order to certify a disabled or handicapped person for a. Disabled persons bus pass application this form only needs completing if you cannot provide us with documents to support your disability. Application form for free bus pass to disabled persons share this select rating give application form for free bus pass to disabled persons 15 give application form for free bus pass to disabled persons 25 give application form for free bus pass to disabled persons 35 give application form for free bus pass to disabled persons 45 give. Otherwise, they will be processed for the following month. Persons with disabilities tap card application metro. Tick to agree i declare that to the best of my knowledge all the statements i have made on this form are true, and i understand that.
Transportation supplementbc bus pass for people receiving. Disabled bus pass application form merthyr tydfil county. Please mail completed order form to the following address. Once this program for free transport for blind visually impaired and handicapped more than 40% physical handicap persons is activated, the existing travel fare benefit programs for visually impaired and. Disabled status card application suite 500, 21 blanshard street, victoria, bc v8w 0b7 section 1. The cost of the bus pass identification cards, including replacement cards, will be publicly posted each year. Duly filled form to be submitted at any esampark centre to get the bus pass issued. In the previous post, we have given the complete details about the kcr kit scheme in telangana. If you are the parent or adult charged by law with the natural parents rights, duties and responsibilities acting on behalf of a minor child under 18 in place of the childs natural parents person in locoparentis, you must complete the information below. Attached photocopy as photo identity proof is declaration.
Each bus pass holder shall be photographed through a web camera and issued a id card cum bus pass. Bus passes shall be issued by computers within 2 minutes. Use form pa2 to apply for long term placard blue renewal side 1 to be completed by applicant 1. Application instructions nall applicants are required to complete,sections 1. The applicant can fill out the bus pass consent to disclosure form pdf and submit via email, fax or mail. The applicant must be a permanent resident in the nottinghamshire county council area, of which proof will be required.
Disabled persons application form network west midlands. Persons with disabilities use this form to apply for a disabled parking placard or disabled parking license plates. Renewal does not require a health professionals signature, but may be. Disabled persons travel pass, we will pass any information you have given us to an independent organisation who will carry out the assessment for us. I understand that on the bus, i mu st tap my mts disabled id card on the farebox or card reade r and for the trolley, i must tap the station validator to be eligible for the reduced fare. Reduced fares on local bus routes and light rail are available to youth ages 618, seniors age 65 and above, persons with disabilities and medicare cardholders. National portal of india is a mission mode project under the national e governance plan, designed and developed by national informatics. Bus pass shall be issued for 123456 barring senior citizens who opt. Additionally, marta has made service plan changes to bus and rail operations to address the dramatic ridership and revenue decline seen in the wake of this national health crisis. Revised 10282019 application instruction sheet thebus person with a disability identification card or pass side 1. Generally, bus pass means, it is a ticket that allows a passenger of the service to take either a certain number of prepurchased trips or unlimited trips within a fixed period of time. Application form for free bus pass to disabled persons.
The person possesses a medicare card and is under 65 years of age. On a bus, pay for a reduced twohour pass or reduced day pass in cash or scan your valid reduced twohour pass, reduced day pass or reduced monthly pass. Senior disabled reduced fares cttransit connecticut. Discounted monthly passes are not available for the ferry or commuter rail. The application for ada paratransit certification must be filled out and signed by you or an authorized individual. Complete the attached application form and mail to. All forms of identification id shall be current or valid. To qualify as disabled for purposes of riptas reduced fare bus pass program you must submit to ripta one of the following. If you use a wheelchair you may board the bus forward or backwards. Approval for the bus pass program will be for 5 years. Georgia department of revenue motor vehicle division person. Passengers must have valid proof of eligibility to use reduced fares. Any person who qualifies for medicare need not have this form certified by a physician, but may obtain a card from the transit.
This is things like a friendship group a walking group an advocacy group. Bus pass replacement form please use this form if your pass has been lost, stolen or not working. Application thebus person with a disability identification. Application form for free bus pass to disabled persons national. I understand that i may lose the use of my reduced fare tap card if i misuse the card, or if i mark, tag or damage transit agency property. Taptogo for eligibility requirements or additional information. The new supplement can be used for an annual bus pass or for other transportation needs. Print or type your name, beginning with your last name, then first name, and then middle initial. The above information provided by me is true and correct and i shall be fully responsible for the same, if it is found incorrect at any. How to get a bus pass if you have a learning disability. Once you and your healthcare provider have completed the appropriate sections, take this application and a separate. Disability travel card application form easter seals canada.
You can also show a tap card from a massachusetts or rhode island regional transit authority rta for reduced commuter rail fares. Generally, bus pass means, it is a ticket that allows a passenger of the service to take either a certain number of prepurchased trips or unlimited. If you dont have documentation to support your disability complete the. The applicant by reason of illness, injury, advanced age, congenital malfunction or other permanent or temporary incapacity or disability, is unable without special facilities or special planning or design to utilize the city bus system as.
Application for issue of bus pass bus pass for ac non ac photo paste here 1. You can only get a bus pass with the second form if you want to use the bus to get to appointments or activities. Complete all lines with trueaccurate information 2. The photo and form both will be attested by the hod authorised signatory of department institution as the case may be. The applicant by reason of illness, injury, advanced age, congenital malfunction or other permanent or temporary incapacity or disability, is unable without special facilities or. In case of general passes, the applicant shall submit hisher identification proof along with photo.
Any person who qualifies for medicare need not have this form certified by a physician or social service agency, but may obtain a card from the transit agency directly upon presentation of his or her medicare card. Page 4 of 4 submitting your application a completed application ready for submission contains the following. This standard is based on the persons inability to stand in a moving bus, trolley, train or subway car even with the aid by holding with the hand of a stanchion or overhead rail. If you are not looking for a bus pass on disability or age grounds you will. Disabled persons concessionary bus pass application form. The persons with disabilities tap card program makes it easy for passengers with disabilities to qualify for reduced fares at tapparticipating agencies. The disability must be recertified before a new or subsequent parking certificate will be issued. Only original, completed, and signed applications are accepted for processing. If you have any difficulties or enquiries regarding the completion of this form, please telephone 0300 500 80 80. A person over 65 years of age qualifies under pennsylvanias free transit program for senior citizens.
Student concession pass application form gsrtc 2018. Bc bus pass program po box 9985, stn prov govt victoria, bc v8w 9r6. Georgia department of revenue motor vehicle division. Thebus person with a disability identification card or pass. If needed, ask the bus operator for assistance when boarding. Thebus person with a disability id card or pass application shall be submitted inperson by the applicant at thebus pass office. This application must also be used for individuals who are recertifying their enrollment in the disability program. The disability travel card holder and their support person must travel on the same train or bus together in the same class of service. Examples of typical ailments which may qualify under this standard. If you require information in a format other than those listed below such as braille please contact the disabled persons railcard office. This supplement is available to every individual with the persons with disabilities designation. Persons with a permanent disability are issued a 6 year certificate. For a parking placard or replacement placard id card, submit this form with applicable fees. It is a sharedride, curbtocurb service that offers independence through mobility and expands access to opportunity via transit.
Show your reduced fare photo id for persons with disabilities to the operator when boarding darts fixedroute buses or to the fare inspector on trains. You can purchase 10ride tickets for 50% of the standard fare at a fare vending machine or ticket booth. Applicants information to be completed by applicant or guardian. Page 2 of 6 persons with medical disabilities application for reduced fare san diego metropolitan transit system mts wi ll notify you if your application is approved within 15 working days contingent upon confirmation from your physician or licensed health care provider if required. Application for reduced fare long form persons with medical. The bus operator will clear the securement area and will attempt to board individuals with a mobility aid prior to boarding others waiting at the bus stop to ensure access to the securement areas. Thebus person with a disability card, pass, or renewal requires a current, completed application, certified by a health care professional duly licensed in the state of hawaii. Please note that in certain circumstances we are required to complete additional checks concerning the information you have submitted on the form. Get a dtc pass department of delhi transport corporation. A person over 65 years of age qualifies under pennsylvanias free. Without special facilities or equipment, and should be afforded a disability bus card entitling himher to reduced bus fare privileges, under the pueblo transit disabled bus pass program.
The reduced fare id card application form is used by nctd to determine if the applicant meets the requirements. Application instructions nall applicants are required to complete,sections 1 2, and 3. A lost or damage pass may be replaced only through reapplication. The pass is valid unless revoked and is nontransferable and nonrefundable, and cannot be used in conjunction with any other pass andor discount. Who can get a bus pass with the second form you can only get a bus pass with the second form if you have a learning disability. Disabled persons bus pass application stokeontrent. This form should not be used to record a change of ownership, change of address, or change of license plate classification. Medicare card in compliance with title 49, part 37, subpart a section 37.
To qualify, a person must possess one of the permanent disabilities as defined on the reverse side of this form. If you have documents to support your disability take them to your nearest pass issuing office. Reduced transit fare program for handicapped persons this program is required by section 5 of the urban mass transportation act of 1964, as amended 1. Information on how to apply for a disabled persons bus pass, and special. Appendix 6 concession certificate form for the purpose of grant of rail concession to orthopaedically handicapped paraplegic persons patients to be used by. Senior citizen may submit this form along with photo id proof and proof of his her age. Replacement cards will be issued with the same end date as the original approval. Orders must be received no later than the 25 th of each month, or by the 21st if a holiday falls within the last 7 days of the month.
N d requirements check appropriate blocks below q q q q q. Print your name last name, first name, middle initial. If you are applying for a san diego metropolitan transit system mts sdm compass card with a statement of disability from a physician, stop and complete the application for reduced fare long form. The easiest way to use the reduced fare program is to get an mcts reduced fare card at the mcts administration building 1942 n 17th st, milwaukee between the hours of 9am and 2pm, monday thru friday. Reg 195, application for disabled person placard or plates. Free bus passes for visually and physically impaired. Tsrtc bus pass apply online application form pdf download. All those receiving a bus pass, including adaeligible individuals, must pay the processing. Viatrans paratransit service via metropolitan transit. Viatrans trips are available for any purpose and can be scheduled at least one day in advance. I understand that the information on this application will be kept confidential by the professionals involved in evaluating my eligibility. Ada application download an ada application how to apply. This form is to be used to request a person with disability parking placard or a disabled persons license plate.
For information on how to fill out this form, see this example form pdf. Apply for or renew a disabled persons bus pass mygov. Disabled person care facility certification we certify that the business named on this form is applying for disabled license plates andor placards primarily for the purpose of transporting disabled persons meeting the conditions explained in section 3 while in our care. Special plate unit, department of licensing, po box 9043, olympia, wa 98507. On the release of information document, please indicate who will fill out your professional verification form. Senior disabled reduced fares connecticut dotowned bus.
402 686 1390 610 1299 1147 293 1254 444 400 608 564 1002 327 157 1358 1237 854 566 194 1081 1289 626 671 99 1124 194 248 390 127 185 477 1059 320 615 766 547 1004 980 545 1101 32