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CBLU Bus Pass Application Form

1. The document is a bus pass application form for Ch. Bansi Lal University in Bhiwani, India. 2. It requests information such as the applicant's name, father's name, address, department, route details, ID proof, and fee payment. 3. The applicant must declare that the information provided is true and correct, and the department must then verify that the applicant is a regular student.

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1K views1 page

CBLU Bus Pass Application Form

1. The document is a bus pass application form for Ch. Bansi Lal University in Bhiwani, India. 2. It requests information such as the applicant's name, father's name, address, department, route details, ID proof, and fee payment. 3. The applicant must declare that the information provided is true and correct, and the department must then verify that the applicant is a regular student.

Uploaded by

Asjsjsjs
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
  • Declaration
  • Bus Pass Application Form
  • Verification by Department

Ch.

Bansi Lal University, Bhiwani


Bus Pass Application Form
Sr. No.____________ Application Type: NEW/ RENEW
Affix one recent
1. Name: _________________________________________________________
passport size color
2. Father’s Name: _________________________________________________ photo here
3. Address: _______________________________________________________
(Attested by HOD/
________________________________ PIN________________________
In-Charge)
4. Department: ___________________ Roll No. ___________________
5. Phone No. _____________________ Mobile No. ________________
6. Route: Bhiwani to ________________ Via _______________________
7. Distance: ____________________ (KM)
8. Duration of Pass : SIX Months____________ to ______________ Sign within the Box for
scanning purpose
9. ID Proof Attached: 1. Aadhar Card 2. University I Card

10. Fee Deposited in ` _______________ Dated: ____________ (Attach receipt in Original)

11. Old Bus Pass Number: ______________________ Dated: ________________________________


DECLARATION:The Above information provided by me is true and correct and I shall fully responsible for the same, if it is
found incorrect at any stage and legal action can be initiated against me. I also affirm and declare that I am not working on
regular or temporary basis.

(Signature of Applicant)
Verification by the Department
It is to verify that the above applicant Mr./ Ms.____________________________ is the regular student

of the ________________ Department, studying in the __________ Semester and his /her application

for the Bus pass may be considered.

Signature of Head / In-charge (Department)


With Seal

Ch. Bansi Lal University, Bhiwani


Bus Pass Application Receipt
Sr. No.___________
Affix one recent
It is to certify that Application for Issue of Bus Pass received from passport size color
photo here
Mr./ Ms. ___________________ S/D/o Sh. ________________________
For Bus Pass From CBLU, Bhiwani to ___________________________
Via ______________________ from _____________ to _________________.
This provisional receipt is valid from _____________ to ____________.

Bus Pass Clerk In-charge (Buss Pass)


(CBLU, Bhiwani) (CBLU, Bhiwani)

Ch. Bansi Lal University, Bhiwani Bus Pass Application Form Sr. No.____________ Application Type: NEW/ RENEW 1. Name: __

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