Companion Bus Pass application form (Torbay)

Introduction

You must live in Torbay to use this application form. If you live in the Devon County Council area, please visit devon.gov.uk/nationalbuspass.

You can use this pass if you live the Devon County Council and Torbay Council areas. To apply as a Torbay resident, you need to:

· live in Torbay
· already have a National Bus Pass issued by Torbay Council
· be secondary school age or over
· have a severe disability which makes it difficult for you to use the bus alone

All information provided below should be for the National Bus Pass holder, not the travel companion. The holder of that pass will, if approved, be issued with a Companion Pass.

Torbay Resident

All information provided should be for the National Bus Pass holder, not the travel companion.

This application form is only for holders of a National Bus Pass issued by Torbay Council.

Are you a Torbay resident with Torbay issued National Bus Pass : *

Yes
No

Unable to apply

If you do not live in Torbay and do not have a National Bus Pass please contact your local authority.

www.gov.uk/find-local-council

Eligibility

You must also provide proof that you live in Torbay. This must be dated within the last 12 months and include your name and address.

Once you have submitted this application, please put supporting photocopied documentation in an envelope, with name and address. You can send it by post to:

Torbay Council, Concessionary Fares Community & Customer Services Lower Ground Floor, Town Hall Torquay, TQ1 3DR

You can also take the envelope to your local library and post in the internal post box.

You must send your own photocopies of original documents. Please note, we cannot accept responsibility for original documents we receive

Eligibility (..contd)

To be eligible you must also provide one of the following to support your application:

Please select the proof you will provide: *

Disability Living Allowance
Letter on headed paper from a medical professional
War Pension
Letter from Children’s or Adult services
Personal Independence Payment
Other

Disability Living Allowance must be higher rate mobility component together with higher rate care component.

Letter on headed paper from a medical professional must confirm a medical condition that that prevents you from travelling alone. For example uncontrolled epilepsy or a severe mental disorder.

War pension with mobility supplement award letter

Letter from Children’s or Adult services confirming you are must confirm you are:

· registered as blind or
· registered with a learning disability and unable to travel alone.

Personal Independence Payment combining at least 2 of the following activities:

· 8 points (or more) for 'moving around'
· 10 or 12 points for 'planning and following a journey'; 8 points for 'communicating'
· 8 points for 'reading'
· 8 points for 'mixing with other people'

Other - Please provide details in the box below

Once you have submitted this application, please put supporting photocopied documentation in an envelope, with name and address. You can send it by post to:

Torbay Council, Concessionary Fares Community & Customer Services Lower Ground Floor, Town Hall Torquay, TQ1 3DR

You can also take the envelope to your local library and post in the internal post box.

You must send your own photocopies of original documents. Please note, we cannot accept responsibility for original documents we receive

Personal Statement

Please use the box below to explain why you need a companion to help you travel by bus. Please note that companion passes are not issued for travel training: *

Contact details

Date of Birth: *

First name: *

Surname: *

Your address

Enter the postcode with a space between 3rd and 4th character. Example TQ1 3DR

House name/number:

Postcode: *

Contact details

Email address: *

Telephone number:
If we call you our number will be withheld.

Declaration

I want to receive a Torbay Council Companion Pass, issued due to my disability.
I understand that I must use the Companion Pass together with my National Bus Pass.
I declare that I am eligible and will follow the conditions of the scheme.
I understand that these conditions may change. All my personal details in this application form are correct. I will return the companion pass if I move out of the Torbay Council area or if I no longer qualify for this pass for another reason.
I also consent that Torbay Council can ask for more evidence if they need it to approve this application.

Data Protection

The information you have provided on this form will be used to deal with your request by the relevant department. We may pass your details on to contracted third party service providers. We will store a copy of your completed request as a backup for 12 months.

If you would like to know more about how we use your information and how you can exercise your information rights please see our privacy notice.

Do you accept these terms and conditions