APPLICATION TO RIDE AS AC ONCESSIONARY PASSENGER ON SCHOOL TRANSPORT

							   Home to School Transport
   Vacant Seats Payment Scheme
   Application to Travel for 2012/2013 Academic Year




Pupils who do not qualify for free transport may be able to travel on a fare-paying basis under the
Authority’s Vacant Seats Payment Scheme. A copy of the full terms and conditions of the scheme are
available on request from the School Admissions & Transport Team. To apply for a seat under the
scheme please complete this form and return it as soon as possible. Applications are processed on a
first come first served basis.
You do not need to send payment at this stage. If you are successful we will send you an invoice
for payment. Once payment is received we will send out your ticket and the travel details. We will
inform you if your application is unsuccessful
If you are in receipt of qualifying benefits please attach confirmation of this with your application.
Please note that seats allocated under the scheme may be needed by statutorily entitled pupils who
begin travelling during the year. In the event of this, we will give you at least two weeks notice of the
change.
A new application must be submitted each year. Renewal forms for the next academic year will
be available from the School Admissions & Transport Team during July 2013.

           Fares per term from September 2012 (Payment Plan)
         £438.00 – per year for the first child
         £366.00 – per year for the second and subsequent children travelling under the
        ….scheme.
                OR
           £410.00 - for full annual payment in advance (a saving of £28) for first child.
           £340.00 - for full annual payment in advance (a saving of £26) for second or
                     subsequent children.

Part 1 – Pupil and Transport Details

School Attended: ………………………………………………………………………………………………
Preferred Pickup Point (if known): ……...………………………………………………………………….
Route Number of Preferred Service (if known): ……………………………………………………..…...
Date that you require transport from: ………………………………………………………………………

Name(s) of Pupil(s) (if you are applying for more than 2 children, please provide details on a
separate piece of paper and ensure it is attached to this form):
1 .…………………….………………………………………… Date of Birth: ……………………………….
2 ……………………………………………………………….. Date of Birth: ……………………………….
Name of Parent/Guardian: ……………………………………………….……………………………………
Home Address: …………………………………………………………..……………………………………..
Post Code: …………………………………………… Telephone Number: ……….……………………….

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HTST VSPS Application 2012/13
Part 2 – Application for exemption from fares

A. Are your children in receipt of Free School Meals?                                                                
OR
B. Do you receive any of the following benefits? Please tick to indicate which benefits apply
   to you and enclose the requested documents with your application form.

Income Support                                                                                                        
Please send all pages of most recent letter from the Department for Work and Pensions detailing
entitlement.
Income Based Jobseekers’ Allowance                                                                                    
Please send All pages of most recent letter from the Department for Work and Pensions detailing
entitlement.
Child Tax Credit                                                                                                      
(Provided your annual income as assessed by the Inland Revenue does not exceed £16,190
and you do not also receive Working Tax Credit).
Please send most recent Tax Credit Award Notice (TC602) or Inland Revenue notice of Change of
Circumstance.
Guarantee Element of State Pension Credit                                                                             
Please send your most recent Pension Credit Award Notice (M1000)
Support under Part VI of the Immigration and Asylum Act 1999                                     
Please tell us the address and telephone number of the National Asylum Support Service office which
is providing support.

Please note that if you receive any of the above benefits you may be entitled to Free School                          
Meals. Please tick this box if you would like to receive more information about this

Part 3 - Undertaking by parent/guardian:

I wish the pupil(s) named above to travel as fare-paying passenger(s). If seats are provided I
undertake to pay the appropriate fee either in full or by entering into a payment plan arrangement with
North Somerset Council.

I wish to pay in full  or by Payment Plan  (unless I am exempt from fares – see Part 2)
I also understand that permission to travel may be withdrawn by the School Admissions & Transport
Team, with a notice period of two weeks, at any time during the school year and that if no other
suitable seat is available, and a proportional refund of fares for that term may be made.
Date: ……………………………………. Signed: ……………………………….……….. Parent/Carer


Please return this form to the School Admissions & Transport Team:
Postal Address: North Somerset Council, Town Hall, Weston-super-Mare, BS23 1UJ
Office Base: Castlewood, Tickenham Road, Clevedon
Email: cyps.hometoschooltransport@n-somerset.gov.uk
Tel: 01934 634715




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HTST VSPS Application 2012/13