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Bus passes and concessionary travel

Older Person’s Concessionary Travel Application Form

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Version 7/OP - June 2012

Not an online form: this form must be printed out, completed by hand, and posted to the County Council (address at the bottom of final page).

For people who have reached the qualifying age based on equalisation of the State Pension Age

If you were born after 5 April 1950, the age you become eligible is tied to changes in the State Pension age for women. This affects both men and women.
See website: http://pensions-service.direct.gov.uk/en/state-pension-age-calculator/home.asp

Data Protection: The information given in this form will be recorded on a computer system subject to the provisions of the Data Protection Act 1998 and may be used for data matching purposes for the detection and prevention of fraud and retained for 12 months. The accompanying personal evidence will be destroyed as soon as your application has been processed.  Telephone numbers are requested as we may need to contact you about your application or if you lose your pass and it is returned.

 
  • Part One - About You

  • Please tick one box only

 
  • I do not currently have any type of
    concessionary travel pass

  • " "

 
  • I am a current holder wanting to change concession (no charge).
    Please return current pass

  • " "

 
  • I am a current holder wanting a replacement due to a lost, damaged or stolen pass.

    Note:  A £10 fee will apply unless accompanied by an official crime number. In case of theft complete Part Two and then go straight to Part Seven to sign and date - no photo is required.

    Crime Number (if applicable): _________________

  • " "

 

Part Two
Personal details

Mr/Mrs/Ms etc:

                               

Forenames

Surname

Date of birth

National Insurance number

Address

     

  

    

Postcode

Telephone:

Email:(optional)

Part Three - evidence of eligibility

Proof of each of the following are required before your application can be processed. Please only send copies and not originals.

  • Name and Address - preferably a copy of an official letter within the last six months e.g gas/electric bill.
  • Date of birth: this must tie up with the correct name eg. a passport

Part Four - Colour passport photograph

Please enclose a recent colour passport-sized photograph for use on your bus pass.
Please clearly write your name and date of birth on the reverse of your photograph.

Part Five – declaration

I confirm that I am a permanent resident in Hampshire and can only have one concession for my sole use to which I am entitled under the Transport Act 2000 and subsequent amendments. I understand that the concession is not transferable and that misuse may result in prosecution. I authorise Hampshire County Council to make any enquiries necessary to verify entitlement for travel concessions. The information given is correct to the best of my knowledge and belief.

Signed:_______________________________

Dated:________________________________

  

Please send your application form, photograph, and copies of evidence to:

Concessionary Travel
P O Box 696
Fareham
PO14 9PD

Telephone: 0845 045 8355
Textphone: 0845 603 5625

(Calls to 0845 numbers are free on some BT call plans but will cost between 4p (local rate) and 6p (national rate) per minute for BT customers not on a plan. Calls made using other service providers or mobiles may cost more).

Email: concessionary.fares@hants.gov.uk