2012 Victorian Public Transport Student Concession Card and Student Pass Application Form

Applying for your card Location of issue Complete this application form to obtain your 2012 Victorian Public Metropolitan Premium Stations Transport (VPT) Student Concession Card (a $9 fee applies). Monday to Friday after 9:30am (some stations may not be able to You must carry your VPT Student Concession Card with you at sell VPT Student Concession Cards and Student Passes between all times when travelling – this is your proof of entitlement to 3:30pm and 6:00pm) travel on a concession fare on metropolitan, V/Line and regional Saturday and Sunday – anytime town bus services. Staffed V/Line stations & V/Line myki agents If you are an eligible primary or secondary student, you can also apply for a half yearly or yearly Student Pass using this form. Call 136 196 for locations and hours of operation Student Passes will be loaded onto a new concession myki The MetShop (if applicable). The myki card fee is waived. It is recommended Melbourne Town Hall, Corner of Swanston and Little Collins that your myki is registered online at myki.com.au or by calling Streets, Melbourne 13 6954 (13 myki). Monday to Friday 9:30am to 5:00pm Victorian Health Care Card Saturday 9:30am to 12 noon If you’ve been issued a Victorian Health Care Card by Centrelink, For further information about these operating times please it can also be used as proof of entitlement. You will not need to call Metlink on 131 638 apply for a VPT Student Concession Card unless you require a student pass. Eligibility criteria What you need to do To obtain a VPT Student Concession Card you must be: • Attending a normal course of full-time study at a School/ Step 1: Complete all sections on the form (excluding Section H), Institution registered with the Victorian Department of Education ensuring that the ‘Declaration’ is signed. & Early Childhood Development as shown in the Victorian Public Step 2: Affix TWO identical original colour passport-quality Transport Approved Schools and Approved Courses photographs to the form. Photographs must be clear head shots in Tertiary Institutions Register; and taken front on. Photocopies, black and white photographs or • A citizen or permanent resident of Australia (Special Category photographs not meeting these requirements will not be accepted. Visa holders excluded). Students with refugee status; a student Step 3: Once the form is completed and photographs affixed, take studying as part of an approved overseas exchange program; the form to the Principal/Bursar/Registrar or Secretary of your or with an Australian Development Scholarship are also eligible School/Institution. They will need to overstamp the photograph (proof such as a letter from your School/Institution is required). (outlined on the form) with the official School/Institution stamp. Unfortunately, you can’t get a VPT Student Concession Card They will also be required to sign and stamp the School/Institution if you’re: Declaration. • Enrolled in a Masters, Doctorate, or other postgraduate course Please note: You must meet the eligibility criteria detailed on • An overseas full-fee paying student (primary, secondary or tertiary) this form. • Enrolled in a tertiary course which is less than 10 weeks duration Step 4: Take the completed form with the appropriate payment • Enrolled in an apprenticeship course to an issuing point for processing (refer: Locations of issue). Payment may be made by cash, debit card, Visa or MasterCard • Enrolled in an off-campus course (not all outlets). • Not studying full-time. Cheques are accepted at metropolitan premium stations and The For more information about public transport services: MetShop. The cheque must have the owner’s name, address, contact number and driver’s licence number printed on the reverse. Metlink (metropolitan Melbourne) Only primary and secondary students may buy a Student Pass Call 131 638 or visit metlinkmelbourne.com.au (conditions apply, see Eligibility Criteria). Viclink (regional Victoria) VPT Student Concession Card Validity Dates Call 136 196 or visit viclink.com.au (for eligible students) Note: • Half Yearly (tertiary only): From 1 January 2012 until 31 July 2012. • Debit and credit cards (Visa and MasterCard only) are accepted. • Yearly (all students): From 1 January 2012 until 28 February 2013. • Staff at the issuing point reserve the right to reject applications that fail to comply with the terms and conditions. Student Pass Validity Dates (for eligible students) • First Half Year: From 1 January 2012 until 31 July 2012. Regional Transit Student Pass number (paper) • Second Half Year: From 1 July 2012 until 28 February 2013. • Yearly: From 1 January 2012 until 28 February 2013. All Student Passes will be electronically issued on a concession myki with exception of Colac School Town Service, Southwest

File Number Transit or Portland Town & Portland North School Town Service Student Passes, which will continue to be issued as paper passes. Place a cross within the appropriate box when selecting an option X . Please use BLACK or BLUE INK and print within the boxes using CAPITAL LETTERS.

Section A: Details of Applicant (Please complete all fields) Title (eg Mr, Mrs, etc) Family name/surname

First given name (in full, no initials) Date of birth D D M M Y Y Y Y Residential Address (please leave a gap between numbers and words)

Unit number/street number/street name

Suburb/town/locality State Postcode

Mailing/Postal Address (please leave a gap between numbers and words)

X Same as above Unit number/street number/street name/PO Box

Suburb/town/locality State Postcode

Contact Details (please provide at least one telephone number) Daytime contact phone number Mobile number (optional)

Email address (optional)

Section B: School/Institution Details and Photographs

If Primary or Secondary Student (please complete)

X Primary X Secondary Year level If Tertiary (please complete)

X Tertiary (yearly) X Tertiary (half yearly) Course name Course start date D D M M Y Y Y Y Expected course completion date Course duration D D M M Y Y Y Y no. of weeks in 2012 Residential Status (please cross one)

X Australian resident/citizen OR X Overseas exchange student, student with a refugee status, or ADS student (proof required e.g. letter from school/college/institution) Secure photo face up ) School Stamp (mandatory) Photographs (mandatory) AFFIX AFFIX Please stamp the photograph, Affix TWO identical original PASSPORT PASSPORT PHOTO LETTERS in the top left hand corner, with PHOTO colour passport-quality L m A m the official School/Institution photographs to the form. stamp. Please DO NOT stamp over Max 36m Min 32m Max 36mm the face of the photograph. Min 32mm s name (in CAPIT (in s name ’ Secure photo face up. Student Section C: School/Institution Declaration

I certify as correct the particulars of the student named on this application form and whose photographs are attached. I have verified these particulars by inspection of the student’s records and I declare that this student is full-time (in 2012) and eligible for a VPT Student Concession Card. I agree that this School/Institution will upon request by a Public Transport Authority# confirm whether or not these particulars remain correct.

Signature of Principal, Bursar, Date Registrar or Secretary D D M M Y Y Y Y

Name of Signatory (please print)

Name of School/Institution (please write full name)

School/Institution Telephone Number Official School Stamp

# Public Transport Authority means Transport Ticketing Authority (TTA), the Department of Transport and any agent, contractor or delegate of TTA or the Department of Transport including Metlink and public transport operators.

Section D: VPT Student Concession Card (Please choose one)

Students attending a TAFE College and studying full-time Tertiary students enrolled in an approved short course of VCE or VCAL are eligible to obtain a VPT Secondary between 10 and 20 weeks may only obtain a Half Yearly Student Concession Card. VPT Tertiary Student Concession Card.

Please cross applicable box X Primary Yearly X Tertiary Yearly X Secondary Yearly X Tertiary Half Yearly

VPT Student Concession Card fee: $9.00

Section E: Student Passes (Available to primary and secondary students only)

Victorian Student Pass Half Yearly Yearly • Entitles the Student to unlimited travel on metropolitan trains, trams, and buses, regional town bus services and V/Line train X $239.00 X $458.00 and coach services operating wholly within Victoria. • This Student Pass is an entitlement electronically loaded onto a concession myki. • The myki card number will be written on the VPT Student Concession Card. Both the myki and VPT Student Concession Card must be carried at all times when travelling.

Regional Transit Student Pass Half Yearly Yearly • These Student Passes, when shown with a valid VPT Student Concession Card, are available for unlimited travel Geelong Transit X $187.90 X $359.00 on all buses within the transit bus system and limited V/Line rail services. Ballarat Transit X $187.90 X $359.00 • Geelong Transit, Ballarat Transit and Bendigo Transit Student Passes will be electronically loaded onto a concession myki. Bendigo Transit X $165.40 X $297.60 • Paper Student Passes will continue to be issued for Southwest Transit, Colac School Town Service and Portland Southwest Transit X $125.90 X $236.40 Town & Portland North School Town Services. • The Regional Transit Student Pass number or myki card Colac School Town Service X $177.90 X $355.80 number will be written on the VPT Student Concession Card. Both the myki and VPT Student Concession Card Portland Town & Portland X $177.90 X $355.80 must be carried at all times when travelling. North School Town Service • These Student Passes are only available from staffed V/Line stations in the regional cities listed (call 136 196 to find out locations). Section F: Terms and Conditions (Please read)

1. Issued subject to the Transport (Compliance and Miscellaneous) Act 1983, Regulations and Ticketing Conditions. 2. You cannot use your school issued student ID card to purchase a concession fare on public transport. 3. You must carry your VPT Student Concession Card when travelling on a student pass or concession fare and present it on request. 4. The VPT Student Concession Card and Student Passes remain the property of the issuing Public Transport Authority#. Lost, stolen or mutilated VPT Student Concession Cards and Student Passes may only be replaced at the place of purchase. A replacement fee applies. Originals, if found, must be returned to the place of purchase. 5. Your VPT Student Concession Card and/or Student Pass can only be used by you and are not transferable to others. 6. It is your responsibility to ensure you continue to meet the ongoing eligibility requirements for your VPT Student Concession Card and if you cease to be an eligible full-time student the VPT Student Concession Card and/or Victorian Student Pass must be returned to the place of purchase.

Section G: Privacy Notice and Declaration (Please read and sign)

You will generally be able to access your personal information. If personal information is not provided we may not be able to provide the card/pass. For further information about privacy and on rights of access to personal information visit myki.com.au or call 13 6954 (13 myki). The personal information you provide on this form is collected by Public Transport Authorities# to issue and administer a VPT Concession card and/or Student Pass, and may be used to issue and administer a myki. Personal information held by Public Transport Authorities# may be used or disclosed (including to each other) to verify entitlement to concession travel; for ticketing enforcement; in emergencies; otherwise as required or authorised by or under law; or with your consent. I agree to the Terms and Conditions on this form and have read the Privacy Notice.

Signature of student Date or parent/guardian D D M M Y Y Y Y

Name of Signatory (please print)

# Public Transport Authorities means Transport Ticketing Authority (TTA), the Department of Transport and any agent, contractor or delegate of TTA or the Department of Transport including Metlink and public transport operators.

Section H: Office Use Only

Type of VPT Student Concession Card issued VPT Concession Card number X Primary X Secondary X Tertiary Half Yearly X Tertiary Yearly

Concession myki card number (Yearly/1st Half Year OR Yearly/2nd Half Year)

Type of Student Pass issued X Victorian Student Pass X Yearly X Regional Transit Student Pass X 1st Half Year Town/Region X 2nd Half Year

Issuing point

Date of issue Date entered into database By (Initials) D D M M Y Y Y Y D D M M Y Y Y Y

Replacement myki card number

Replacement Regional Transit Student Pass number (paper) Regional Transit Student Pass number (paper)

Replacement VPT Concession Card number Date of issue Date entered into database

D D M M Y Y Y Y D D M M Y Y Y Y F-STCN-2011 Registration Form

Use this form if you: • already own a myki and want to register it; OR • want to purchase and register a new myki.

(Only one myki can be registered/purchased per form).

If you are deaf, or have a hearing or speech impairment, It’s easy to learn more about myki contact us through the National Relay Service: • TTY users phone 133 677, then ask for 13 6954 (13 myki). Visit myki.com.au • Speak and listen users phone 1300 555 727, then ask for Call 13 6954 (13 myki) 13 6954 (13 myki). If you need an interpreter: • Call the Translating and Interpreting Service (TIS National) on 131 450 and ask for 13 6954 (13 myki). General Information

Post this form to Benefi ts of registering your myki myki Mailbox • The balance on your myki will be protected should you Reply Paid 4318 report it lost or stolen. MELBOURNE VIC 8060 Option: (No stamp required) • to have your name printed on your myki to differentiate it from other mykis in your household. (To take up this option Or lodge this form at cross the appropriate box in Section D.) • to manage your myki with an online account. • The myki discovery centre at Southern Cross Station • of auto top up for ‘set and forget’ convenience. • The MetShop (Melbourne Town Hall, corner of Swanston and Little Collins Streets) myki auto top up Visit myki.com.au for location details. myki auto top up is a smart way to always stay topped up with myki money. It is an automated payment to your myki Administration fee from a linked bank account or credit card whenever your An administration fee of $9.80 applies to some card myki money is running low. With auto top up, you simply services including requesting a replacement myki or set and forget. balance transfer. Please visit myki.com.au for details Once you receive your myki, the account holder can set on when the $9.80 fee applies. up auto top up at myki.com.au, or by completing a myki Auto Top Up Request Form or by calling 13 6954 (13 myki). Privacy You can obtain more myki Registration Forms by visiting The Transport Ticketing Authority (TTA) understands and myki.com.au or by calling 13 6954 (13 myki). respects your right to privacy and we are committed to privacy protection. The Information Privacy Act 2000 and TTA’s Privacy Policy regulate how we collect and handle your personal information. Visit myki.com.au or call 13 6954 (13 myki) for further information about privacy or our Privacy Policy. General Information

Section A – Account Holder Details • Victorian Seniors Card holders

The myki will be registered under the account holder’s details. Please carry your Victorian Seniors Card when travelling with The account holder is the person who will manage the myki myki as this is proof of your concession entitlement. and will be responsible for it. The account holder could also A Commonwealth Seniors Health Card cannot be used as a be the cardholder (see Section B). form of concession ID. However, there are instances where the account holder If you are eligible to receive free travel vouchers there is no will set up an account for another person who will be the change to the way these vouchers will be issued or used. cardholder. For example, a parent or guardian (account holder) may set up an account for their child (cardholder). • Interstate Seniors Card holders The account holder will have access to the registration Seniors Card holders from all other Australian states and details of the cardholder and information relating to the territories can purchase a concession myki. Please carry your use of the myki. Seniors Card when travelling with myki as this is proof of your concession entitlement. Section B – myki Cardholder Details Section C – Register an Existing myki The cardholder is the person who will use the myki to travel. A myki is non-transferable and can only be used If you already have a myki and want to register it, please by the cardholder. complete all sections except Section D. The cardholder’s name can also be printed on the myki. Registration is free. This is optional and only available when purchasing a new registered myki. Section D – Purchase a New Registered myki Important notes for concession cardholders If you would like to purchase a new, registered myki, please You must carry your concession card with you at all times complete all sections except Section C. when travelling as this is proof of your concession entitlement. Please select the myki type by crossing X in only ONE box. • Children under 4 years If you are purchasing a new registered myki using this form, Children aged under 4 years travel free on public transport there is an initial charge for every new myki issued ($10 for and do not require a myki. full fare and $7 for concession). • Children (4 - 16 years) You can also choose to top up your new registered myki using A child myki is required for travel. However, proof of this form. Simply enter a dollar value between $1 and $50. entitlement is not required for children aged 4-16 years. The advantage of purchasing a myki topped up with myki money is that you can travel with your card as soon as it arrives. If you require a Student Pass on your myki, you must carry a Victorian Public Transport (VPT) Student Concession Card If you are posting this form, please fi ll in your credit card details at all times. in Section E to make a payment. If you are lodging this form, you can pay by cash, EFTPOS or credit card. • Students To purchase a student myki, please do not use this form. Visit myki.com.au for more information on where to obtain a student myki. If you are aged 17 years or over, you must carry a VPT Student Concession Card as proof of your concession entitlement when travelling with a concession myki. • Victorian Health Care Card holders and Pensioner Concession Card holders When travelling with a concession myki please continue to carry your current Health Care Card*^ or Pensioner Concession Card^ (issued by Centrelink or the Department of Veterans’ Affairs). If you are eligible to receive free travel vouchers there is no change to the way these vouchers will be issued or used.

* Only Health Care Cards with a Victorian address are valid. ^ Please note: the concession applies only to the cardholder and does not extend to any dependants named on the card, even when they are travelling with the cardholder. Registration Form

How to complete this form

• Place a cross X within the appropriate box when selecting an option. • Please use BLACK INK and print within the boxes using CAPITAL LETTERS. Registration starts once the form is processed. This may take up to 10 days. If you provide us with your email address we will contact you to confi rm that registration has been completed. For immediate registration visit myki.com.au or call 13 6954 (13 myki). If you are: • registering a myki you already own, please complete all sections except Section D. • purchasing a new myki by posting this form, please complete all sections except Section C. If you are the cardholder AND account holder of the myki, you need to complete both Sections A and B, and sign both boxes provided in Section E. This also applies for legal guardian/agents applying on the applicant’s behalf.

Section A: Account Holder Details

The myki will be registered under the account holder’s details. The account holder is the person who will manage the myki and is responsible for it. The account holder could also be the cardholder. However, the account holder may also be a parent or guardian setting up an account for their child or dependant (the cardholder).

Account Holder Title (Mr, Mrs, Miss, Ms, other) Given name

Family name

Date of birth D D M M Y Y Y Y

Postal Details

Unit number Street number

PO box number

Street name

Suburb/town

State Postcode

Contact Details (Please provide at least one telephone number) Daytime phone number (with area code) Mobile number

Email address (Please complete using CAPITAL LETTERS. If the email address is too long for one row of boxes please make use of the second row provided)

Preferred Method of Contact (Please choose at least one) X Mail X Telephone X Email

FRQ-M-001-W Page 1 of 4 Section B: myki Cardholder Details

The cardholder is the person who will use the myki to travel. A myki is non-transferable and can only be used by the cardholder. The account holder will have access to the registration details of the cardholder and information relating to the cardholder’s use of the myki.

X Same as above, where the cardholder is the same person as the account holder. Please go to Section C. OR If the cardholder is NOT the same person, please complete the details below. Title (Mr, Mrs, Miss, Ms, other) Given name

Family name

Date of birth D D M M Y Y Y Y

Email address (Please complete using CAPITAL LETTERS. If the email address is too long for one row of boxes please make use of the second row provided)

IF YOU ARE: • REGISTERING AN EXISTING MYKI, PLEASE COMPLETE SECTION C AND GO TO SECTION E. • PURCHASING A NEW, REGISTERED MYKI, PLEASE SKIP SECTION C AND GO TO SECTION D.

Section C – Register an Existing myki

If you already have a myki and want to register it, please provide us with your myki card number below, skip Section D then read and sign Section E.

Card number of the myki you wish to register

The 15-digit card number can be found on your myki.

GO TO SECTION E – PLEASE READ AND SIGN THE PRIVACY NOTICE AND DECLARATION.

Section D – Purchase a New Registered myki

If you would like to purchase a new, registered myki, then you must select a category below by crossing ONE box that applies to the cardholder.

X Full Fare or one of the concession types below X Child (16 years and under) X Victorian SeniorX Interstate Senior X Victorian Health Care Card holder X Pensioner myki card price – Please enter $10 for Full Fare or $7 for Concession. $ . 0 0

Add myki money (Optional) $ . 0 0 You can also choose to top up your new, registered myki with myki money, allowing you to travel with your card straight away. Simply enter a dollar value between $1 and $50.

Total – Please add the myki card price above and myki money top up amount (if applicable). TOTAL $ . 0 0

Would you like to have the cardholder’s name printed on the myki? X Yes X No myki pass – When you receive your myki, you can also purchase a myki pass (travel days) by visiting myki.com.au, calling 13 6954 (13 myki), or visiting a participating retailer or train station. You cannot use this form to purchase a myki pass.

SECTION D CONTINUED ON NEXT PAGE.

FRQ-M-001-W Page 2 of 4 Section D – Purchase a New Registered myki (cont.)

Credit Card Details (Only required if you are posting this form)

The myki card price and myki money top up amount (if applicable) will be debited from your credit card.

Credit card type X VisaX MasterCard

Name on credit card

Credit card number Expiry date on credit card M M Y Y

Signature of credit card holder

credit card holder please sign Date D D M M Y Y Y Y

PLEASE READ AND SIGN THE PRIVACY NOTICE AND DECLARATION IN THE NEXT SECTION.

Section E: Privacy Notice and Declaration

The account holder or cardholder (‘you’) will generally be able to access your personal information. If personal information sought by the Transport Ticketing Authority (TTA) (‘we’ or ‘us’) is not provided, we may not be able to provide the Card and related services, such as registration. For further information about privacy and on rights of access to personal information, visit myki.com.au or call 13 6954 (13 myki). Personal information provided by or about you or generated by using the Card is collected by Public Transport Authorities# to issue and administer the card and relevant entitlements. Personal information held by Public Transport Authorities# may be used or disclosed (including to each other) for the operation of myki; to verify entitlement to concession travel; for ticketing enforcement; in emergencies; otherwise as required or authorised by or under law; or with your consent. We may send you information about transport-related services. We may contact you about other goods and services which we consider may be of interest, unless you have opted out by crossing the box below or subsequently through the contact details provided. A cardholder’s personal information may be disclosed to an account holder. # Public Transport Authorities means TTA, the Department of Transport and any agent, contractor or delegate of TTA or the Department of Transport including Metlink and public transport operators.

X I DO NOT wish TTA to contact me about other goods and services which it considers may be of interest.

THIS DECLARATION MUST BE SIGNED BY BOTH THE CARDHOLDER AND ACCOUNT HOLDER.

I agree to the Terms and Conditions on this form and have read the Privacy Notice.

Signature of account holder or legal guardian/agent for applicants unable to sign

account holder please sign Date D D M M Y Y Y Y

Signature of cardholder (if different to account holder) or legal guardian/agent for applicants unable to sign

cardholder please sign Date D D M M Y Y Y Y

Legal guardian/agent name (if applicable)

Relationship to applicant (if applicable) Legal guardian/agent telephone number (with area code)

FRQ-M-001-W Page 3 of 4 Section F: Terms and Conditions

Your myki is issued subject to, and its use is governed by, the myki Terms of Use, the Transport Act 1983 and Regulations, and the Victorian Fares and Ticketing Manual (‘Ticket Conditions’), as amended from time to time. The myki Terms of Use limit TTA’s liability and may impose certain fees. To obtain a copy or for further information visit myki.com.au or call 13 6954 (13 myki). If your registered myki is lost or stolen, balance protection commences once you have reported it. You can report this at myki.com.au or by calling 13 6954 (13 myki). Replacement of a lost, stolen, damaged or defective myki requires completion of a Replacement myki Form. An administration fee may apply. If your details change, you need to inform TTA. To change your details visit myki.com.au or call 13 6954 (13 myki). Section G: myki Offi ce Use only

Date Location of lodgement D D M M Y Y Y Y

Name of staff member

FRQ-M-001-W Page 4 of 4