Diamond Travelcard application form
for over 60s 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:

- Somerset House, Oxford Street, Weston-super-Mare (until the end of March 2009)
- 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 photos 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:

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

[] I am over 60 years old and will abide by the conditions of the scheme 
as detailled in the current Diamond Travelcard booklet.

[] I am a permanent resident of North Somerset and the address on page 7 is 
my sole and princriple 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: