ANDHRA PRADESH STATE ROAD TRANSPORT CORPORATION

STUDENT BUS PASS APPLICATION ABOVE SSC

Previous ID Card No (2016-17) :
1. Student 10th Details
1.1 SSC Board Type :
APSSC
CBSE
ICSE
ORIENTAL
APOS
OTHER BOARD

1.2 SSC Pass Type :

Regular
Supplementary
1.3 SSC Year of pass : 1.4 SSC hall ticket no :
2. Student Details
2.1 Name :
Photo
2.2 Father's / Guardians
Name :
Date of Birth
Male
2.3 (dd/mm/yyyy) : 2.4 Gender :
Female
As Per SSC

2.5 Aadhar No. : 2.6 Mobile No :

2.7 Is Employee Children :
Yes
NO If Yes Enter Emp. Id :
2.8 Email :
3. Residential Address Details
3.1 District : 3.2 Mandal :
3.3 Village : 3.4 Address :
4. Institution Details
4.1 Institution Code : 4.2 District :
4.3 Mandal : 4.4 Institution Name :
4.5 Course Name : 4.6 Present Course Year :
4.7 Admission No : 4.8 Institution Address :
5. Route Details
5.1 Center : 5.2 Pass Type :
5.3 From Place District : 5.4 To Place District :
5.5 From Place: Via: To:
Enclosures: Bonafied Certificate, SSC Memo
I hereby declare that the particulars given above are true and found correct. I will abide by the rules & regulations of
APSRTC governing issue of Bus Passes.

Signature of Head of the Institute Signature of the Student

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BONAFIDE CERTIFICATE

I hereby certify that Sri/kum/Smt is bonafide student of (Name of the

Institution) studying (Name of the course) With Admission No & Roll No His /Her

Date of Birth is (DD-MM-YYYY) as per office records and the course will be completed by

(dd/mm/yyyy).Educational Institute Recognition Code No (As per the D.E.O. records). Course Code No

for the Academic year 2017-2018.

Date:

Place: Principal