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.
Please tick one box only
I do not currently have any type of
concessionary travel pass
I am a current Hampshire County Council holder wanting to change concession (no charge).
Please return current pass
I am a current Hampshire County Council 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 Five to sign and date - no photo is required.
Crime Number (if applicable): _________________
Date of birth
National Insurance number
Proof of each of the following are required before your application can be processed. Please only send copies and not originals.
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.
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.
Please send your application form, photograph, and copies of evidence to:
P O Box 696
Telephone: 0300 555 1376*
Textphone: 0300 555 1390*
*Calls to 0300 numbers are included in call packages, or charged at the same rate as 01 and 02 numbers. Costs may vary depending on your telecoms provider and whether you are calling from a landline or mobile. Further information about call charges can be found at www.ofcom.org.uk