MTA Reduced-Fare MetroCard Conditions of Use and Other Important Information for a Metropolitan Transportation Authority Reduced-Fare MetroCard (RFM) issued to people 65 years of age and older (LI Bus, 60 or older) and people with disabilities. This program is managed by MTA New York City Transit. Valid Use: RFM can be used to pay fares on all MTA The holder assumes the risk of loss until the card is received New York City Transit subways, NYC Transit local buses, by either MetroCard Customer Claims or the MetroCard express buses only during non rush hours, MTA Staten Island Service Center. Railway, MTA Long Island Bus, MTA Bus, Roosevelt Island Change of Address: Notices and replacement cards will be Tram, Westchester Bee-LIne local buses and express Bee- sent to you at the address you provide. You must inform us Line BxM4C buses only during non rush hours. promptly, in writing, of any change of address. The RFM is valid identification for eligibility in the reduced-fare Lost or Stolen RFMs: Immediately report a lost or stolen programs of the MTA Long Island Rail Road and MTA Metro- RFM by calling the MetroCard Customer Service Center, North Railroad, anytime except weekday rush hours to New 212- METROCARD, or TTY/TDD 718-596-8273, weekdays 7 York City terminals. To receive the reduced fare, show the a.m. to 11 p.m., weekends 9 a.m. to 5 p.m. Any value or RFM to train personnel or station agents when purchasing unlimited rides on your card will be transferred to your your ticket. replacement RFM after the old RFM has been frozen and any Expiration Dates: Reduced-Fare MetroCards expire on the balances verified. date printed on the back of the card. NYC Transit automatically Restrictions: An RFM may be used only by the person to sends you a new RFM before the expiration date. whom it has been validly issued. Use of the RFM by any other The full value on an expired RFM may be transferred to a new person may result in forfeiture of the card and its remaining RFM at a subway station booth. Any remaining value that is balances, plus civil and/or criminal penalties. not transferred to a new RFM within two years after the LI Bus reduced-fare cards available to persons 60 years of expiration date on the original RFM will be surrendered by, and age do not qualify for reduced fares on NYC Transit. At age unavailable to, the card holder. 65, these customers receive NYC Transit Reduced-Fare Trouble Using RFMs: An RFM that does not work or is MetroCards. damaged should be returned to MetroCard Customer Claims. There are no refunds of money remaining on RFMs. Money Ask a station booth agent or bus operator for a prepaid remaining on an expired card may only be transferred to a new envelope in which to return your card to us. In the envelope card within two years of the expiration date. Money from a full- you’ll find a form to fill out so you can describe your RFM fare MetroCard cannot be transferred to a temporary or problem. permanent RFM. No redemptions or exchanges will be given If you prefer, you may bring your damaged RFM to the for an RFM that has been altered or tampered with, or whose MetroCard Customer Service Center at 3 Stone Street in value cannot be verified. downtown Manhattan, 9 a.m. to 5 p.m., Monday to Friday. The City of New York, the State of New York, the County of If you cannot get a prepaid mailer, send the damaged card to: Westchester and the Metropolitan Transportation Authority and its subsidiaries and affiliates, including New York City MetroCard Customer Claims Transit, are not liable for any special or consequential 130 Livingston Street damages associated with or resulting from the failure, Brooklyn, New York 11201-9625 malfunction, or disabling of the RFM or the MetroCard system. Be sure to include your name, address and phone number, The MTA Reduced-Fare MetroCard and its use are your damaged RFM, an explanation of the problem and the subject to all tariff provisions, rules and regulations of address to which the new RFM should be sent. the New York City Transit Authority and its affiliates, and Westchester County Bee-Line System. For more information, call 212-METROCARD Monday to Friday 9 a.m. to 5 p.m. For TTY/TDD call 718-596-8273, Monday to Friday 7 a.m. to 11 p.m., within New York City. Outside the city, call 800-METROCARD. Have the card at hand so you can read the serial number and expiration date to the customer service agent who assists you. 352_07 mta Application for MTA Reduced-Fare MetroCard for Senior Citizens Request Type I New I LI Bus (60+ yrs) Customer Type or print in ink and sign where indicated. Last Name First Name M.I. Street Address Apt. No. City/Borough State Zip Code – – –– Home Telephone Work/Other Telephone – – – – – Date of Birth Your Social Security Number (optional) Code Male Female Proof of age documentation; photocopy of one of the following must be attached (check box): I Birth Certificate I Driver’s License I Medicare Card I Other ______________________________ ALL INFORMATION WILL BE KEPT STRICTLY CONFIDENTIAL Information For telephone assistance in completing this application and for answers to questions about it, call 212-METROCARD (63 8-7622). If you are unable to complete the form yourself, it can be completed by anyone you choose to assist you or you can visit our NYC Transit Reduced Fare Service Center located at 3 Stone Street in downtown Manhattan, Monday to Friday 9 a.m. to 5 p.m. or MetroCard Bus to apply in person. If you apply in person, you must bring an official photo ID with your birthdate indicated. You do not 2" need this application notarized when you apply in person. A photo will be taken. If you are mailing this application, you must submit a recent photograph. Please write your name on the back of the photograph. The photograph must be at least two inches high and one- and-a-half inches wide (2" x 1 1/2") with a solid background showing a full front view of your face. Please see diagram at left. All information provided by you will be used solely for the purpose of determining your eligibility for 1 1/2" the reduced-fare transportation. Every question on this application must be answered. Incomplete applications or applications submitted without photographs will be returned to you. Allow two to four weeks for processing. over www.mta.info mta Affirmation I am a senior citizen 65 years or older (LI Bus, 60 If the MTA should find that I have not followed the or older). I affirm under penalty of perjury that all Reduced-Fare Program Conditions of Use, I understand statements made on this application, which the that my Reduced-Fare MetroCard will be cancelled and I Metropolitan Transportation Authority relies on to will not be eligible to reapply for the reduced-fare determine my eligibility status, are true and complete . program. I have read and understand all the information contained I understand that it is a crime to allow anyone else but in this application. I understand that all statements made me to use the MTA Reduced-Fare MetroCard. in this application may be subject to investigation and verification and that a material misstatement or fraud By signing this application I (1) acknowledge that I have will disqualify me for reduced-fare privileges. read the enclosed Conditions of Use for MTA Reduced- Fare MetroCard and (2) accept and agree to be bound I understand that the MTA may discontinue or change by such conditions of use. its reduced-fare program without notice. Applicant’s Signature X ___________________________________________________ Date ________________ or Personal Representative _________________________________________ Date ________________ (print name) Notary Public State of ______________________________________________} ss: County of _____________________________________________} Must be completed for all applicants, On this ______ day of_______________, 20 ________ before me appeared except when _________________________________________________________________________ applying in person, to me known and known to me to be ( Check the one that applies. ) with photo ID. I the person who is described in and who executed the foregoing instrument I the personal representative of the applicant named above and who executed the foregoing instrument on behalf of the applicant. and (s)he duly acknowledged to me that (s)he executed the same and that the statements therein are true. Signature and stamp of officer ______________________________________________ NOTARY PUBLIC If you need information given to you in a different way, check box(es) below: I Large print I Other (specify):___________________________________________________ For further information or additional copies of the application, call 21 2-METROCARD: 1- 718-59 6- 8273 TTY/TDD (for people with hearing impairments). Mail completed application to: Metropolitan Transportation Authority Reduced-Fare Program 130 Livingston Street Brooklyn, New York 11201-9625 For Office Use Only Disk # _______________________________ Image # ____________________________ Examiner’s Signature ______________________________________________________ mta OPTIONAL – Sign up for EasyPay automatic refills and get a month of free rides* (All payment information will be kept strictly confidential.) Start paying for your rides with $10 by selecting one of the payment options below. Your account will be automatically replenished whenever the balance goes below $10. Your account immediately converts to unlimited rides when the required number of subway or local bus rides is taken within a 30-day billing period. Monthly statements will be sent to you. Payment Options (choose one) 1 Credit Card I American Express I Discover I MasterCard I Visa I I I I I I I I I I I I I I I I I I /I I Credit/Debit Card Number Expiration Date I authorize MTA New York City Transit to charge this credit card for my EasyPay MetroCard refills.