Free Weekend Travel Application Form

This form is for use by:  Victorian Seniors Card holders  Disability Support Pensioners  Carer Payment recipients to access the free weekend travel entitlement, which will be issued on a free myki.

For more information about myki

Visit ptv.vic.gov.au Call 1800 800 007
If you are deaf, or have a hearing or speech impairment, contact us through the National Relay Service:  TTY users phone 133 677, then ask for 1800 800 007.  Speak and listen users (speech-to-speech relay) phone 1300 555 727, then ask for 1800 800 007. If you need an interpreter:  Call the Translating and Interpreting Service (TIS National) on 131 450 and ask for 1800 800 007.

PTV7541/13

General Information
All Victorian Seniors Card holders, Disability Support Pensioners and Carer Payment Recipients are eligible for a free myki which contains a free weekend travel entitlement. Your myki will automatically give you free travel on weekends within any two adjacent zones (e.g. Zones 1 and 2) in Victoria when you touch on and touch off. You must carry both your myki and a valid Victorian Seniors Card or Centrelink Pensioner Concession Card with you in order to travel free on weekends. To be eligible for free weekend travel, you must be either:  a Victorian Seniors Card holder, or;  a Centrelink Disability Support Pensioner, resident in Victoria who is under 60 years of age, or;  a Centrelink Carer Payment recipient, resident in Victoria who is under 60 years of age. Seniors Card or Pensioner Concession Card holders from other States and Territories are not eligible for free weekend travel, however they are entitled to travel on concession fares on public transport in Victoria. How to apply for free weekend travel To obtain a free myki containing the free weekend travel entitlement, complete and post this form to: myki Weekend Travel Applications PO Box 6422 St Kilda Road Central Melbourne VIC 8008 Privacy Public Transport Victoria (PTV) understands and respects your right to privacy and is committed to privacy protection. The Information Privacy Act 2000 and PTVs Privacy Policy regulate how we collect and handle your personal information. Visit ptv.vic.gov.au or call 1800 800 007 for further information about privacy or our Privacy Policy. Visit ptv.vic.gov.au or call 1800 800 007 if you require further copies of this form.

Free Weekend Travel Application form

How to complete this form
Place a cross X within the appropriate box when selecting an option. Please use BLACK INK and print within the boxes using CAPITAL LETTERS. Unless stated, all elds are mandatory. Please read the Privacy Notice and the Terms and Conditions and sign where indicated.

Title (Mr, Mrs, Miss, Ms, other)

Given name

Family name

Unit number

Street number

PO box number

Street name

Suburb/town

State

Postcode

Daytime phone number (with area code)

Date of birth (dd/mm/yyyyy)

Email address (Optional)

Victorian Seniors Card Number

Are you a DSP/CAR pensioner? Yes No

If yes, what is your customer Reference Number (CRN)

SPF-M-003-W

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General Information
Privacy Notice
The account holder or cardholder (you) will generally be able to access your personal information. If personal information sought by Public Transport Victoria (PTV) (we or us) is not provided, we may not be able to provide the Card and related services, such as registration. For further information about privacy and on rights of access to personal information, visit ptv.vic.gov.au or call 1800 800 007. Personal information provided by or about you or generated by using the Card is collected by Public Transport Authorities# to issue and administer the Card and relevant entitlements. Personal information held by Public Transport Authorities may be used or disclosed (including to each other) for the operation of myki; to verify entitlement to concession travel; for ticketing enforcement; in emergencies; otherwise as required or authorised by or under law; or with your consent. We may send you information about transport-related services. We may contact you about other goods and services which we consider may be of interest, unless you have opted out by crossing the box below or subsequently through the contact details provided.
#

Public Transport Authorities means PTV, the Department of Transport and any agent, contractor or delegate of PTV or the Department of Transport including public transport operators.

I DO NOT wish PTV to contact me about other goods and services which it considers may be of interest.

I AGrEE tO thE tErMs AnD COnDitiOns On this fOrM AnD hAvE rEAD thE privACY nOtiCE. Your myki is issued subject to, and its use is governed by, the myki Terms of Use, the Transport (Compliance and Miscellaneous) Act (1983) and Regulations, and the Victorian Fares and Ticketing Manual (myki) (Ticket Conditions), as amended from time to time. The myki Terms of Use limit Public Transport Victorias (PTV) liability and may impose certain fees. To obtain a copy or for further information visit ptv.vic.gov.au or call 1800 800 007. Balance protection starts once you report your registered myki as lost or stolen at ptv.vic.gov.au or by calling 1800 800 007. To replace a myki that is lost, stolen or not working you must complete a Replacement myki Form. The replacement of a lost or stolen registered myki can also arranged by phone calling 1800 800 007. If your details change, you need to inform PTV. To change your details visit ptv.vic.gov.au or call 1800 800 007. Signature of applicant or legal guardian/agent if applicant unable to sign

please sign

Date (dd/mm/yyyyy)

SPF-M-003-W

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