ANDHRA PRADESH STATE ROAD TRANSPORT …

1 ANDHRA PRADESH STATE road TRANSPORT corporation STUDENT BUS PASS APPLICATION ABOVE SSC Previous ID Card No (2016-17) : 1. Student 10th Details SSC Board Type : APSSC cbse ICSE ORIENTAL APOS OTHER BOARD SSC Pass Type : Regular Supplementary SSC Year of pass : SSC hall ticket no : 2. Student Details Name : Father's / Guardian s Name Date of Birth (dd/mm/yyyy) As Per SSC : Gender : Male Female Aadhar No. : Mobile No : Is Employee Children : Yes NO If Yes Enter Emp. Id : Email : 3. Residential Address Details District : Mandal : Village : Address : 4. Institution Details Institution Code : District : Mandal : Institution Name : Course Name : Present Course Year : Admission No : Institution Address : 5. Route Details Center : Pass Type : From Place District : To Place District : From Place: Via: To: Enclosures: Bonafied Certificate, SSC Memo I hereby declare that the particulars given above are true and found correct.

2 I will abide by the rules & regulations of APSRTC governing issue of Bus Passes. Signature of Head of the Institute Signature of the Student ---------------------------------------- ---------------------------------------- ---------------------------------------- ------------------------------------- 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 records). Course Code No for the Academic year 2017-2018. Date: Place: Principal Photo.