BANGALORE METROPOLITAN TRANSPORT CORPORATION

(Students Bus Pass Application) Pass No:

To be filled in Block letters

Full Name: ……………………………………………………………… Affix a recent

DoB:……………………….…………Age:…………………… stamp size
Gender: ……………………………… Photo of the
Category: GM/Other (OBC)/SC/ST………………………….. applicant with
Present Postal address:……………………………………………………….……… seal & sign of
Door #:………………………… Street:…………….. institution
Locality:……………………….pin code:…………….
Name of the Parent/guardian: …………….
Permanent address………………... Contact Tel.No: ………………..
………………………………. Email Address: …………………
………………………………. Aadhar No………………………
Are you staying in Hostel: Yes No:
If yes, Hostel Address ----------------------------
………………………………………………………………………..
Are you staying in residential School: Yes No

Student’s Requirement : Ordinary pass / Travel as you like pass / 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

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Certificate from Educational Institution
The above information furnished by the student studying in our Educational Institution is true as
per our record.

Student’s Registration No: Signature of Head of the

Institution with seal & Date
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Terms& 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 4) Copy of the Aadhar Card
Rules to be followed
Pass 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 Pass after due Police
formalities in case of loss during the validity period.
Office use only ( To be filled in by the official deployed for scrutinizing pass application)
Pass No: __________________ Pass Rate: _______________
Total distance travelled by student in KMs ______________
Total stages travelled by Student _______________________
Remarks Examined person name & signature