application for mobility pass

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application for mobility pass
APPLICATION FOR MOBILITY PASS
The Mobility Pass exempts the pass holder from ticket validation requirements. A valid Mobility Pass must
have the appropriate validating sticker affixed to the relevant month and entitles the holder to unlimited
travel/transfer on all Adelaide Metro bus, train and tram services for the currency of that month.
APPLICANT’S DETAILS
Title (please circle)
Surname
Given Names
Residential Address
Suburb
Dr, Mr, Mrs, Miss, Ms
Postcode
If Postal Address is different to Residential Address please provide details:
Postal Address
Phone Number
Date of Birth
Home
Mobile
Email
Signature of Applicant
Date:
/
/20
THIS SECTION IS TO BE COMPLETED BY A MEDICAL PRACTITIONER OR A
QUALIFIED PROFESSIONAL FROM AN AGED, DISABILITY OR CARE SUPPORT
AGENCY.
I certify that …………………………………….…..is unable to physically validate metrocards onboard the bus, tram and train services, for the following reasons:
……………………………………………….:..............................................…………………….
......................................................................................………………………………………...............
................................................................................…………….………………………………………
…………………………………………………………………………………………………………………
……………………………………….…………………………………….
1) Efforts have been made to assist the applicant to use and validate a metrocard independently
prior to this application.
Yes
No
2) Physical impairment is the reason for this application.
Yes
No
3) If cognitive impairment is the primary reason for this application, a medical and/or other
supporting documentation, attesting to inability to validate a metrocard, must be
attached.
As ............................………....…….....…. cannot manage the physical validation of a metrocard,
I RECOMMEND that a Mobility Pass be issued to her/him.
Signature: .........................................………………………..………………Date:
/
/20
Name ..............................……..Position:.............................…………Phone: ……………....
Support Agency (If applicable) ………………………………………………………………………….
Address: ……………………………………………………………..…. ……..Postcode: ..................
OFFICE USE ONLY
Approved By
Document #: 9213000 Version: 1
Date
Page 1 of 2
/
/20
MOBILITY PASS INFORMATION
The Department for Planning, Transport and Infrastructure (DPTI) has a Mobility Pass available to
people who are unable to validate a metrocard using on-board equipment due to physical or
cognitive impairment. A cognitive impairment can incorporate intellectual disability, dementia,
acquired brain injury or other disability.
The Mobility Pass exempts the pass holder from metrocard validation requirements. The
laminated Mobility Pass features the name and photograph of the pass holder.
A valid Mobility Pass must have the appropriate validating sticker affixed to the relevant month and
entitles the holder to unlimited travel/transfer on all Adelaide Metro bus, train and tram services
for the currency of that month.
The Mobility Pass must be carried when traveling on all Adelaide Metro bus, train or tram services
and shown to Operation Staff (drivers) when boarding the transport vehicle. The Mobility Pass can
be worn around the neck on a lanyard, making it easier to handle and less likely to be lost or
misplaced.
THE PROCESS
A Medical Practitioner or a Qualified Professional from an aged, disability or care support agency,
certifying to the applicant’s inability to use the ticketing and validation system, must assess
applicants for a Mobility Pass.
The application is then forwarded to the Concessions Administrator, Department of Planning,
Transport and Infrastructure, Public Transport Service, GPO Box 1533, ADELAIDE SA 5001 for
consideration. The Concessions Administrator will advise the applicant in writing of the outcome
of the application.
Mobility Passes for approved applicants are available from the Adelaide Metro InfoCentre, located
at the corner of King William and Currie Streets, ADELAIDE where a photograph is taken of the
approved applicant and the Mobility Pass produced.
There is no cost for the production of the Mobility Pass. However, the validating monthly sticker
must be purchased at the cost of forty (40) Concession Metrocard peak fares per month.
Aged, disability or care support agencies can arrange for the issue of a Mobility Pass to their
clients and can purchase the validation stickers on their behalf. Under this arrangement, these
agencies are advised to purchase the monthly sticker prior to the commencement of the month to
ensure that the pass holder receives their full monthly entitlement.
Officers of the DPTI understand that some passengers may have communication, memory or
comprehension difficulties. Bearing this in mind, if at any time a passenger is found to be traveling
without a Mobility Pass, every effort will be made to assist the person and explain the need to carry
the Pass before any action is taken relating to the issue of an Expiation Notice.
Please note that the Mobility Pass must be renewed annually and the validating stickers
must be purchased on a monthly basis. Failure to do so may mean the pass is invalid for
use.
Product Distribution Officer – Adelaide Metro
Department of Planning, Transport & Infrastructure
Document #: 9213000 Version: 1
January 2015
Page 2 of 2

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