North West Karnataka Road Transport Corporation

(Application for Student Bus Pass)

Affix the Photograph
attested by the Head of the
Divisional Controller, Institution.
North West Karnataka Road Transport Corporation,
…………………………Division.
Passport Size
Photo

Name (IN BLOCK LETTERS)...........................................................................

Father’s Name .....................................................................................................
Date of Birth.........................................................Class................................
Primary/ Middle school High school College/Degree Diploma/Professional/ITI
Education Institution Name / address :……………………………………………..
………………………………………………………………………….
Gender : Male Female .
Aadhaar No ..............................................................................
Category : GM Other (OBC) SC ST
Caste certificate No……………………………………….(for SC/ST students)
E-mail ID…………………………………………….. Mobile No…………………….
Permanent Address……. ...................................................................................................
…….......................................................................................................................
Temporary Address :…………………………………………………..
…………………………………………………………………………..
Pass Route: From ………………………. …….To ………………………………..
Route change place………………………………………………………………….
Pass Duration: From ………………….……..To ………………… ……………..
School/college fee Receipt No.……… …………....Date……………….………
I will not misuse this pass.

Parent/Guardian Signature Student Signature

Date:
……………………………………………………………………………………………..
Confirmation from Educational Institution
The above information is correct. It is certified that students’ personal details mentioned
above are as recorded in our Education Institution.

Student Registration No.:…………………………………………..

Principal/Head Master/ School/College/University Seal

Head mistress Signature Date:
……………………………………………………………………………………………..
For office use only
Pass / Card No………………………….….
Validity of pass ………….. to ………………
Chargeable stages ………………………………
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