Bus Pass Application Form

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					                                                                      ID Number - for office use only



                                                                     Concessionary Fares
                                                                     Dover District Council
                                                                     White Cliffs Business Park
                                                                     Dover, Kent CT16 3PJ
                                                                     Phone: 01304 872122
                                                                     Fax:       01304 872330
                                                                     Minicom: 01304 820115
                                                                     E-mail: confares@dover.gov.uk

      Your Full Name:

      Address:




                                                                                       Details of the scheme and the
                                                                                    application form can be found on our
                                   Postcode:                                        website under concessionary fares at:
                                                                                   www.dover.gov.uk/concessionary_fares
      Is this your main residence?          YES       NO


      Date of Birth:           /        /


      Your daytime phone number:(optional)


                        APPLICATION FOR CONCESSIONARY FARES
                                    Please make sure that you sign the declaration on page 3

                                                  Helpline 01304 872122
         You can take your application form and any proof required to any of these @ Your Service offices

         Office               Address                       Opening Hours
         Council Offices      White Cliffs Business         9.00am to 5.00pm Monday to Friday
                              Park, Whitfield

         Dover Gateway        Castle Street                 9.00am to 5.00pm Monday to Friday
                                                            9.00am to 1.00pm Saturday

         Deal Office          The Town Hall                 9.00am to 12.30pm and 1.30pm to 4.30pm
                                                            Tuesday, Thursday and Friday
                                                            Closed all day Monday and Wednesday afternoon

         Sandwich Office      The Guildhall                 9.00am to 12.30pm and 1.30pm to 4.30pm
                                                            Tuesday and Thursday

         Aylesham Office      Aylesham House                9.00am to 12.30pm and 1.30pm to 4.30pm
                                                            Monday




Or you can post this form with any proof required to the Council offices at the address on the top of this form




                                                                 1
                                   Application for a Concessionary Bus Pass
The bus pass is issued free of charge and provides free travel on bus services at or after 9am weekdays and at any
                            time at weekends and on public holidays, throughout Kent.


            Please provide 1 recent passport size and style photo with this application. Please write your name
            and date of birth on the back of the photo and enclose it in an envelope attached to this form.

                        Please tick one box to indicate the category you are claiming in
                You can claim a bus pass if you are aged 60 or over

                Please provide proof of your date of birth

                 You can claim a bus pass if you have a disability from one of the following groups

                                     Please provide proof of your disability.
             This can be a DWP payment book or letter, a KCC registration card or medical evidence.
  If you do not have any medical evidence, please ask for a medical form to be sent to your health professional

                A walking impairment to such a degree that you could claim the high rate of the mobility element of
                Disability Living Allowance or the War Pensioners Mobility Supplement.


                Without use of both arms



                Without speech



                Profoundly or severely deaf



                Blind or partially sighted



                Have a learning disability since childhood as defined by the Transport Act 2000

A bus pass to include a companion is available for purchase by residents who are claiming because of a
                   disability and are unable to travel alone because of their disability.
 Please call the helpline on 01304 872122 for the cost of this type of pass and for methods of payment.

                Please tick here if you require a bus pass to include a companion



                You can claim a bus pass if you have either been refused or would be refused a driving licence for
                medical reasons

                Please provide your licence application refusal (DVLC D206/D235) or medical evidence

                Please tick here if you are applying for a bus pass on behalf of a child under 18 or as an appointee
                or agent

                You will be asked for proof of your right to sign for the applicant for example a benefit award letter or
                power of attorney
 Equality
             Please sign the declaration on page 3 - THE BUS PASS WILL BE POSTED TO YOU

                                                                  2
The Race Relations Amendment Act (2000) says that we need to make sure that we deal with everyone equally
and fairly. It would help us to know your ethnic background, so we can make sure our services meet your needs.
We will only use this information as the law allows.

    Please choose one section from 1 to 5, then tick the box that describes your cultural background.

1   White                                2    Mixed                               3     Asian or Asian British
    British                                   White and black Caribbean                 Indian
    Irish                                     White and black African                   Pakistani
    Any other white background                White and Asian                           Bangladeshi
                                              Any other mixed background                Any other Asian background
    Please tell us below                      Please tell us below                      Please tell us below


         4     Black or black British                          5       Other ethnic groups
               Caribbean                                               Chinese
               African                                                 Afghan
               Any other black background                              Kurdish
                                                                       Roma
                                                                       Any other background
               Please tell us below                                    Please tell us below


Declaration - Please read and sign

I accept that the details I have given will be retained on a computer database for the purposes of administering
the concessionary fares scheme and may be used by the council to cross check against other council records.
I confirm that the bus pass or travel vouchers issued to me will only be used in accordance with the terms and
conditions of the scheme. A leaflet is available on request.
I confirm that I have lived or intend to live in this district for a period of not less than 6 months.
I confirm that I will return my bus pass or unused travel vouchers if I move permanently out of the district.


Signature:                                                                      Date:

         Please provide 1 recent passport size and style photo with this application. Please write your name
         and date of birth on the back of the photo and enclose it in an envelope attached to this form.




                                                FOR OFFICE USE ONLY
    Application received
                                                                                              Receipt
                                      Payment received (companion pass only)                  number
Office date stamp

                                             Evidence seen

                                             Checked by




      Application processed
                                        Concession number
Office date stamp

                                        Start Date


                                        Expiry Date


                                        Processed by




                                                                   3

				
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