DELHI TRANSPORT CORPORATION
(Govt. of N.C.T. of Delhi)
Application Form for New Bus Pass (Student Category only)
(To be filled in Capital Letter only)
1 Name of the Applicant
2 Name of Father
D D M M Y Y
3 Date Age: Ph.
of Birth
4 Residential Address: _______________________________________________________________________
_____________________________________________________________ Pin
5 Type of Pass Required (Tick only one)
6 Information Required for Destination Pass
Place From: ___________________ To: __________________
7 Period of Pass Required
Date From: ____________________To: __________________
8 Name Address and Code No. of the Educational
. Institute:
(1) Name and Address
________________________________________________________
(2) Class:
(3) Student Identify Card No.:
(4) State whether Employed or Not
Roll No.:
Student’s Signature
It is certified that the columns filled by the student are correct and have been verified from our record
and it will be valid for 5 months. The certificated is valid for two weeks from the date of issue.
Dated: / /
Signature of the Principal/Head of the Institute
(Office Stamp with Address)
Destination
All Route Non-AC
All Route AC
Code No.
Paste Recent
Photograph & get it
attested by the
Principal / Head of
Institute.
