PÀ£ÁðlPÀ gÁdå gÀ¸ÉÛ ¸ÁjUÉ ¤UÀªÀÄ

KARNATAKA STATE ROAD TRANSPORT CORPORATION

APPLICATION FOR STUDENT PASS 2024-25

«zÁå ¸ÀA¸ÉܬÄAzÀ PÉÆqÀ¨ÉÃPÁzÀ zÀÈrüÃPÀgÀt ¥ÀvÀæ / Certificate from Educational Institution

«zÁåyðAiÀÄ ºÉ¸ÀgÀÄ / Student Name………………………………

d£Àä ¢£ÁAPÀ / Date Of Birth ...………… °AUÀ / Gender………

Photo with
«zÁåyðAiÀÄ zÁR¯Áw ¸ÀASÉå / Student Registration No………….
Signature
PÉÆøÀÄð / Course ……………. ªÀµÀð / Year…………….

SATS / UUCMS ID…………………..

«zÁå¸ÀA¸ÉÜAiÀÄ ºÉ¸ÀgÀÄ ªÀÄvÀÄÛ «¼Á¸À / Institution Name & Address
.…..……………………………………………………………………………………
………………………………………………………………………………………..
………………………………………………………………………………………..

«zÁåyðAiÀÄ ªÁ¸À¸ÀܼÀ «¼Á¸À / Student’s Residental Address

…………………….......................................................................................................
.......................................................................................................................................
………………………………………………………………………………………...

Pass Travel Route

EAzÀ / From Place…………………………ªÀgÉUÉ / To Place………………………..
ªÀiÁUÀð §zÀ¯ÁªÀuÉ ¸ÀܼÀ / Via Place…………………………………………………….

ªÉÄÃ¯É ¤ÃrgÀĪÀ «zÁåyðAiÀÄ ªÉÊAiÀÄQÛPÀ «ªÀgÀUÀ¼ÀÄ, «zÁå¸ÀA¸ÉÜAiÀÄ zÁR¯ÁwAiÀÄ°è £ÀªÄÀ ÆzÁVgÀĪÀAvÉ

EgÀÄvÀÛzÉ JAzÀÄ F ªÀÄÆ®PÀ zÀÈrüÃPÀj¸À¯ÁVzÉ.

It is certified that students’ personal details mentioned above are as recorded in our
Education Institution.

±Á¯É / PÁ¯ÉÃdÄ / «±Àé«zÁ央AiÀÄzÀ ¥ÁæZÁAiÀÄðgÀÄ / ªÀÄÄSÉÆåÃ¥ÁzsÁåAiÀÄgÀÀ

ªÉƺÀgÄÀ …………. ¸À» ªÀÄvÀÄÛ ¢£ÁAPÀ………….
School / College / University Principal / Head Master
Seal………………… Signature and Date……..