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TRAVEL PASS FOR A PERSON WITH VISION IMPAIRMENT

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					                                          APPLICATION FOR
      TRAVEL PASS FOR A PERSON WITH VISION IMPAIRMENT
    The Travel Pass entitles the holder to unlimited FREE travel on Adelaide Metro regular bus, tram and train
               services and must be produced immediately to an authorised person, upon request.

    Public Transport InfoCentre, DTEI – Public Transport Division, PO Box 1 WALKERVILLE SA 5081
                             (corner King William and Currie Streets, Adelaide)
             Tel: InfoLine (08) 8210 1000, InfoCentre (08) 8303 0936 or Fax (08) 8410 4847

                                          APPLICANT’S DETAILS
Title (please circle)        Dr, Mr, Mrs, Miss, Ms
Surname
First Name
Postal Address
Suburb                                                            Postcode
Phone Number                 Home                                 Mobile
Date of Birth

•    I apply for a “Travel Pass for a Person with Vision Impairment”
•    I am a permanent resident of South Australia.
•    Completed Medical Certificate is below.

Signature of Applicant and/or witness ………………………………………………..Date                                   /       /200

Name of Witness (if applicable)       …………………………………………………….
2 Photographs are: Enclosed                   Not Enclosed              to be taken at InfoCentre

                                          MEDICAL CERTIFICATION
I certify that I have examined         Dr, Mr, Mrs, Miss, Ms (please circle)
Enter full name of patient

an applicant for a “Travel Pass for a Person with Vision Impairment” and certify that he/she
is legally blind as determined by the meaning of “permanent blindness” under the Social
Security Act 1991 (Commonwealth).

Name of Medical Practitioner
                                                                                                     /    /200
Signature

Practice/Surgery stamp
Phone No:

                                             OFFICE USE ONLY
Application Approved     Yes         No           Pass No. & Date issued

Remarks

Signature.............…………………………...........…………(Supervisor OPT)              Date ………/…………/200…………
                                      APPLICATION FOR
       TRAVEL PASS FOR A PERSON WITH VISION IMPAIRMENT

ELIGIBILITY INFORMATION
An applicant must complete this application, providing personal details, certification of residency
together with verification of blindness and forward it to the Supervisor (InfoCentre/InfoLine)
Department for Transport, Energy and Infrastructure, Public Transport Division, PO Box 1,
WALKERVILLE SA 5081.

An Ophthalmologist, Optometrist or a Medical Practitioner can provide the medical certificate. To
assist with the quick processing of applications, it would be appreciated if the doctor’s practice
details can be stamped in the indicated space, together with the contact telephone number.
Please note that any fees payable in connection with the medical certification are to be paid by the
applicant.

Two passport size coloured photographs (head and shoulders) are required. If the application is
posted, photos should be certified on the back by either a Justice of the Peace, Police Officer,
Bank Manager, General Practitioner or Minister of Religion. Photographs can be taken at
photographic booths located at most shopping centres. However, photos can also be taken, free
of charge, at the Passenger Transport InfoCentre located at the corner of King William & Currie
Streets, Adelaide.

PROCESS
Upon verification of eligibility and receipt of photographs, a plastic photographic identification card
will be produced and posted to the applicant within a week. The Travel Pass is a ten-year plastic
photographic card with the current Pass expiring on 31/12/2015.

ENTITLEMENTS

The Travel Pass entitles the holder to unlimited FREE travel on Adelaide Metro regular bus, tram
and train services and must be produced immediately to an authorised person, upon request.
However, it is good practice to show the Travel Pass to the driver upon boarding the vehicle.

When arranging travel bookings with Great Southern Railways Limited (GSR) telephone 13 2147,
please have your Centrelink Pensioner Concession Card with you.

If you are planning to travel intrastate or interstate, additional information can be obtained about
travel entitlements on rail, airlines or bus services from the Royal Society for the Blind - telephone
(08) 8232 2444 or direct from the travel companies/agencies involved.

Melissa Tucker
Project Officer - Concessions & SATSS.
PUBLIC TRANSPORT DIVISION                                                                 JUNE 2006

				
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