Victorian War Veteran Travel Pass

Victorian War Veteran
Travel Pass
Information and application form
This Travel Pass is issued to War Veterans who:
>
have undertaken overseas war/peacemaking/peacekeeping
service; AND
> receive a Department of Veterans’ Affairs (DVA) Gold or
White card or documented evidence of ongoing or lump sum
compensation from DVA for an injury /illness related to this
service; AND
> have had confirmed by their treating doctor that due to this
injury / illness related to service the veterans locomotion is
limited significantly; AND
> are residents of Victoria.
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Victorian War Veteran Travel Pass – Information and application form
How to apply
1. Complete this application form.
2. Obtain one colour passport photograph.
3. Return this application form to:
War Veterans Travel Pass Applications
PTV Hub
PO Box 4724
Melbourne VIC 3001
4. PTV will verify your information and assess your application.
Please note:
>original applications and photographs cannot be returned
under any circumstances
>
incomplete applications cannot be processed
>if successful in qualifying for the War Veteran travel pass,
your card will be posted to you.
Victorian War Veteran Travel Pass – Information and application form
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What is classified as approved overseas
war service?
Documentary evidence of overseas war service from one of the
following theatres of war:
>
World War 2
03/09/1939 – 28/04/1952
>
Korea
27/06/1950 – 19/04/1956
>
Malaya
29/06/1950 – 30/09/1967
>
Vietnam
31/07/1962 – 29/04/1975.
OR
ADF / Peacemakers: Association Papers as documentary
evidence of related conflicts (but are not limited to):
>
Afghanistan (War on Terror and UNMCTT)
>
Africa (Sierra Leone, Namibia, Somalia, Rwanda, etc.)
>
Cambodia
>
East Timor
>
Gulf War 1 and 2.
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Victorian War Veteran Travel Pass – Information and application form
Where can I use the War Veteran
Travel Pass?
The Travel Pass entitles the pass holder to free travel on:
>train, tram and bus passenger services operating in
metropolitan Melbourne;
>train and coach passenger services operated by V/Line
throughout regional Victoria; and
>other public transport services (such as regional town buses)
operated under contract with Public Transport Victoria.
Free travel passes do not necessarily apply to NSW TrainLink,
Great Southern Railway, airport services, tourist railways, privately
run bus services and chartered trains, trams and buses. Please
check with the relevant operator before booking or travelling.
Victorian War Veteran Travel Pass – Information and application form
5
How much does the War Veteran
Travel Pass cost?
The War Veteran Travel Pass is free of charge.
How do I get a replacement pass?
The pass holder must advise PTV on (03) 9027 4930 as soon
as possible if the Travel Pass is lost, stolen, damaged or
non-operational including if they become aware that the name
or photograph is illegible. A free replacement Travel Pass will
be issued.
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Victorian War Veteran Travel Pass – Information and application form
Section 1: Applicant’s details
Please tick all relevant boxes where applicable.
Title: (please tick)
Mr
Mrs
Miss
Ms
Surname or family name:
First or given name:
Male
Female
Date of birth:
/
/
Contact address:
Suburb:
State:Postcode:
Phone – home:
Phone – mobile:
Email (if available):
DVA file number:
Disability rate:
Location of overseas war service:
Please note: Documentation of overseas war service is required.
Victorian War Veteran Travel Pass – Information and application form
7
Section 2: Applicant declaration
Please tick all relevant boxes.
I confirm that the signature below declares the following:
>
that the information in this application is correct.
Yes
No
>
that I am a resident of Victoria.
Yes
No
>
I have attached a colour photocopy of my DVA gold or white
card or photocopy of documentary evidence of ongoing
or lump sum compensation for an injury / illness recognized by
the Department of Veterans’ Affairs.
Yes
No
>
I have attached documentary evidence of my overseas
war service.
Yes
No
>
My treating doctor has completed Section 3 in regards to my
injury / illness limiting my mobility significantly.
Yes
No
>
I have read, or had explained to me, and accept the War
Veteran Travel Pass terms of use – Section 5.
Yes
No
>
I have read, or had explained to me, the War Veteran Travel
Pass Travel Pass privacy notice – Section 6.
8
Yes
No
Victorian War Veteran Travel Pass – Information and application form
>
I authorise that these details may be verified with the
Department of Veterans’ Affairs.
Yes
No
Applicant signature:
Applicant signature (must be 16 years and over):
Date:
/
/
Please note: if the applicant is unable to sign the application, the
applicant’s guardian or agent must complete and sign the section
below.
Guardian / Agent details
I declare that I have read and explained the contents of this
application to the applicant, and that the details of the applicant
set out in this application are correct.
Guardian / Agent name (and relationship to the applicant):
Guardian / Agent phone number:
Guardian / Agent signature for applicants unable to sign (must be
18 years and over):
Signature:
Date:
/
/
Victorian War Veteran Travel Pass – Information and application form
9
Section 3: Certificate of incapacity
To be completed by your doctor (please use BLOCK LETTERS)
This is to certify that I, Dr
have on this day
/
/
medically examined
Mr/Mrs
of
(address)
and have found that his / her disability as excepted by Department
of Veteran Affairs (DVA) is a result of a war related injury in
accordance with injury number below (if injury is number 8, please
complete the space provided under number 8).
10 Victorian War Veteran Travel Pass – Information and application form
List of injuries
1. B
oth legs amputated, or rendered permanently and wholly
useless above the knees.
2. N
egligible powers of locomotion so as to be capable of moving, with the aid of crutches or walking sticks, for short
distances only.
3. B
oth arms amputated, or rendered permanently and
wholly useless above the wrists.
4. B
oth legs amputated, or rendered permanently and wholly
useless below the knees.
5. O
ne leg amputated, or rendered and wholly useless above
or below the knee.
6. O
ne leg amputated, or rendered permanently and
wholly useless above or below the knee and one arm
amputated, or rendered permanently and wholly useless,
below the elbow.
7. Incapacitated to an extent that is similar in effect or
severity to the extent of incapacity associated.
8. F
or any other reason handicapped with regard to
locomotion to a degree of handicap of locomotion
associated with any of the disabilities described above.
(Please specify nature of condition(s) below and how it
significantly effects the Veteran’s mobility)
Victorian War Veteran Travel Pass – Information and application form 11
Employer name:
Business address:
Suburb:
State:
Business phone number:
Signature:
Professional stamp
AHPRA registration number:
12 Victorian War Veteran Travel Pass – Information and application form
Postcode:
Section 4: Photograph
35mm
JOHN SMITH
45mm
This photograph is a true
likeness of John Smith
Margaret Brown
Amcal Pharmacist Glenroy
18-8-11
Attach one recent colour passport photograph.
If submitting this form:
In person to the PTV Hub at 750 Collins Street, Docklands,
the passport photo can be verified by a staff
member. Processing of your application will take
10 working days.
By post
to PTV Hub PO Box 4724, Melbourne VIC 3001,
please have a Justice of the Peace print your full
name on the back of the photo and sign, certifying
it is a true likeness of you.
The photograph is kept on file to make it easier for you to
receive a replacement Travel Pass if it is lost, stolen, becomes
non-operational or damaged.
Victorian War Veteran Travel Pass – Information and application form 13
Section 5: Terms of use
1.Only the person whose photograph and details appear
on the Travel Pass is permitted to use the pass.
2.The pass holder must carry their Travel Pass at all times
when travelling on Victoria’s public transport network.
3. The Travel Pass remains the property of PTV.
4.Representatives of public transport authorities may inspect,
deactivate, suspend, hotlist or take possession of the Travel
Pass or require its return at any time if the pass holder is in
breach of the terms of use.
5.PTV may change these terms of use from time to time.
The current version of the terms of use may be obtained
by calling the PTV Hub on (03) 9027 4930. Where PTV
reasonably considers that any such change will have more
than a minor detrimental effect on travel for pass holders
generally, the change will be notified by PTV to pass holders
in advance in writing.
6.The pass holder must not alter, tamper or interfere with the
Travel Pass.
7.The pass holder agrees to advise PTV as soon as possible
if the Travel Pass is lost, stolen, damaged or non-operational,
including if they become aware that the name or photograph
is illegible.
8.A free replacement Travel Pass will be issued for all lost,
stolen, damaged and non-operational travel passes.
14 Victorian War Veteran Travel Pass – Information and application form
Section 6: Privacy notice
PTV is collecting your personal and health information to
facilitate the assessment of your eligibility for, and issuing and
administration of, a Travel Pass. Where necessary, PTV may
disclose your personal information to the Department of Economic
Development, Jobs, Transport and Resources for purposes
associated with the administration of public transport ticketing
laws. Your personal information will otherwise only be used or
disclosed by PTV if permitted under privacy law.
If you choose not to provide certain information (such as your
name, address, or other contact details) as requested, PTV may
be unable to process your application for a Travel Pass.
You are entitled to contact the PTV Information Privacy Officer
(contact details are set out below) and request access to any
personal information about you that is held by PTV.
PTV will take reasonable steps to correct and update any of
your personal information that is established to be inaccurate,
incomplete or not up to date or provide you with a written
statement if such a request is refused.
For more information, please refer to PTV’s Information Privacy
Policy, available at ptv.vic.gov.au, or contact PTV’s Information
Privacy Officer using the details below:
PTV Information Privacy Officer
PO Box 4724, Melbourne VIC 3001
Phone: 1800 800 007 (6am – midnight)
Email: [email protected]
Victorian War Veteran Travel Pass – Information and application form 15
Section 7: Contacts for more information
For all War Veteran Travel Pass enquires you can contact
the following services for assistance:
Public Transport Victoria
Phone:
(03) 9027 4930
Visit staff: At the PTV Hub at
750 Collins Street,
Docklands, VIC 3008.
Open Monday to Friday
8am to 6pm.
Website: ptv.vic.gov.au
National Relay Service:
13 36 77
Speech-to-Speech Relay Service:1300 555 727
Multilingual information
For all War Veteran Travel Pass phone enquiries
in languages other than English, please use the following
phone numbers:
Arabic
Cantonese
Croatian
Dinka
Greek
Italian
Macedonian
9321 5440 9321 5441 9321 5442 9321 5452 9321 5443 9321 5444 9321 5445
Mandarin
Somali
Spanish
Sudanese
Turkish
Vietnamese
All other foreign languages 9321 5450
16 Victorian War Veteran Travel Pass – Information and application form
9321 5454
9321 5446
9321 5447
9321 5453
9321 5448
9321 5449
For more information or to offer
feedback visit ptv.vic.gov.au or call
1800 800 007 (6am – midnight)
Public Transport Victoria is your central stop for
information on public transport services, tickets,
improvement projects and to provide customer
feedback. Up-to-date information is available via
our website, call centre and mobile applications.
PTVH1398/15. Authorised by Public Transport Victoria,
750 Collins Street, Docklands