Diamond Travelcard application form
for 60+ applicants


Council documents can be made available in large print, audio, easy read and other formats. 
Help is also available for people who need council information in languages other than English.

For more information contact the Diamond Travelcard Office on 01934 426 426 or email: diamond.travelcard@n-somerset.gov.uk.


You can return your completed form by post to: 
North Somerset Council, Diamond Travelcard Office, Somerset House, Oxford Street, Weston-super-Mare, BS23 1TG. 

You can return it in person to:

- the Town Hall, Walliscote Grove Road, Weston-super-Mare
- any North Somerset Library
- the For All Healthy Living Centre, Lonsdale Avenue, Weston-super-Mare


The technology involved in printing passes means that we cannot print them instantly for personal callers. However, we can accept and check application forms at any of the above locations, forms will then be forwarded to the Diamond Travelcard Office where they will be printed and dispatched.

Please attach a recent passport sized photograph to your application. 
The photo should show head and shoulders only with no headgear. 
Please print your name on the back in case it gets separated.

Title: []Mr   []Mrs   []Miss   []Ms    Other (please state):
First name:
Middle name(s):
Last name:

Sex:  []Male   []Female

Date of birth:  

Address:
House name or number:
Street:
Village:
Town:
Post code:

Telephone number (including STD code): 
Email address:

Previous pass number (if any):

Would you like to receive future correspondence in large print?  []Yes   []No


If you need the assistance of a companion at all times when travelling on buses, you will need to ask your GP or consultant to fill in this section and ask them to stamp this form with their practice stamp:

Name and address of GP or consultant:
Contact telephone number:
Signature:

Declaration
I wish to apply for a Diamond Travelcard and I declare that:

[] I am of an eligible age and will abide by the conditions of the scheme as detailed in the current Diamond Travelcard booklet.

[] I am a permanent resident of North Somerset and the address I have provided is my sole and principle residence.

[] All the information I have given is correct. I understand that if I lose my
new Diamond Travelcard there will be a replacement fee.

Signed:
Date:


***FOR OFFICE USE ONLY***

[] Photo
[] Proof of residence
[] Companion medical evidence

Proof of age:
[] Birth certificate
[] Pension
[] Passport
[] Driving licence
[] Other

Card number:
Initials:
Date of issue:
Office stamp:

Data protection act:

This information will be used by North Somerset Council, the Department for Transport, bus operators, and appointed contractors to administer the Diamond Travelcard service and may be used to monitor bus usage. It may also be used internally for research into travel services. Your name and other identification details may also be used in the council's contact centre for the purposes of improving your access to any of the council's services. The Diamond Travelcard itself will only hold your name, card number and expiry date.

The council is under a duty to protect the public funds it administers and may use information you have provided in order to prevent and detect fraud. We may, therefore, also share this information with other bodies responsible for auditing or administering public funds for this purpose, including the Audit Commission, and the council's auditors. Please contact the council's Corporate Information Management team for any queries about data protection.