Professional Documents
Culture Documents
ptv.vic.gov.au
What is myki?
myki is the ticketing system used on metropolitan public transport, V/Line interurban trains and major regional town bus services. When a passenger boards a train, tram or bus they must touch on their myki at a myki reader, located at railway station entrances and doorways of trams and buses. Touching on ensures the holder has a valid ticket for travel. When leaving the station, tram or bus, the passenger must touch off. Touching on and off public transport is important to ensure that: >> the holder has a valid ticket for travel >> railway station gates are opened for entry or exit at gated stations >> data is collected to assist with transport planning.
Replacement cards
If the Access Travel Pass is lost, stolen, damaged or non-operational, including if the name or photograph becomes illegible, please contact Public Transport Victoria on 1800 800 007 as soon as possible. A free replacement Access Travel Pass will be issued. If lost or stolen, a Statutory Declaration must be completed and submitted to Public Transport Victoria before a replacement Access Travel Pass can be issued.
How to travel while waiting for your replacement Access Travel Pass
Once you have reported your Access Travel Pass lost or stolen, a new one will be posted within ve to ten working days. If you need to travel in the meantime, the PTV Hub at 750Collins Street, Docklands can provide you with atemporary pass for travel until your new myki Access TravelPass arrives.
Surname or family name: First or given name: Date of birth: Postal address: Suburb: State: *Phone home: *Phone mobile: *Email (if available): *Note: if you chose not to provide some or all of the optional information requested, your Access Travel Pass may not be able to processed. 1.2 Are you a permanent resident of Victoria?
Postcode:
Yes No Y ou are not eligible for issue of the Access Travel Pass.
1.3 Have you previously applied for the Access Travel pass?
Yes No
1.4 Are you able to travel independently, without the assistance of a constant carer/companion on Victorias public transport services? (Please tick one)
Yes No Y ou are not eligible for issue of the Access Travel Pass. However, you may be eligible for: >> Companion Card vic.companioncard.org.au >> Multi-Purpose Taxi Program transport.vic.gov.au
1.6 Describe how your condition impacts on your ability to touch on and off (use) the myki system (eg limited hand movement, ability to reach scanners, balance, mental illness/condition).
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2.2 Please provide the following signatures: Applicant signature (must be 16 years and over): OR Guardian/Agent signature if applicant unable to sign or under 16 years old). Signature:
Date:
2.3 Guardian/Agent details (if applicable) Guardian/Agent name (and relationship to the applicant)
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Registered Medical Practitioner Registered Psychologist Clinical Psychologist Registered Psychiatrist Clinical Psychiatrist Registered Physiotherapist ccupational Therapist eligible for membership of O Occupational Therapy Australia (Victoria).
3.2 The applicant has been in my professional care for: Years months
3.3 Is the condition/s permanent? (permanent means: the condition is not likely to improve with time or medical treatment, such as further surgery)
Yes No
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3.4 Is the applicant able to travel independently using the public transport network? (independent means: no assistance is required to board or alight public transport or to determine the appropriate train, tram or bus route or stop)
Yes No
3.5 Can the applicant independently touch on and off their myki?
Yes No
3.6 Please describe the impact of the applicants condition on their ability to touch on/off using the myki ticketing system as per the legal requirements.
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3.7 Health professional details My signature conrms, in my professional opinion, that all of the following are true: >> I have read all the information provided by the applicant on this form and verify that it is correct to the best of my knowledge. >> The applicant is able to travel independently on Victorias public transport network. >> The applicant has a signicant and permanent disability and is unable to touch on or touch off a myki at the myki readers independently and/or consistently. >> I am not the applicant, or an immediate family member of the applicant. >> I agree to offer all reasonable information to assist in the assessment of the applicants eligibility for the Access Travel Pass. >> I have signed the reverse of the applicants photograph and conrm it is a true likeness of the applicant.
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Name: Employer/Business name: Business address: Suburb: State: Business phone number: Signature: Postcode:
Date:
Australian Health Practitioner Regulation Agency (AHPRA) registration number: Please provide the following information on the back of the applicants passport photograph: This photograph is a true likeness of (applicants name) Your name Your provider number Your signature Date of signature
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Section 4: Photograph
35mm
45mm
A photograph is NECESSARY for ALL applicants. It is recommended that the passport photographs be taken before the appointment with the healthcare professional, so they can sign the back of the photo at the same time as completing Section 3 of this form. Afx the recent (within 3 months) colour passport photograph to the form for the health care professional to sign with the application. The colour passport-size photograph: >> must be 35mm x 45mm and a clear head shot with the applicant facing forward >> must have the applicants full name printed on the reverse of the photograph and be signed and dated by the healthcare professional completing this form. Please note: >> Photocopies or black and white photographs will not be accepted. >> The photograph will be scanned and kept on le to make it easier to get a replacement Access Travel Pass if it is lost, stolen or becomes non-operational.
Access Travel Pass Information and application form
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>> complete and submit a Statutory Declaration to Public Transport Victoria if their registered myki is lost or stolen; >> upon request, show the Access Travel Pass to any Authorised Ofcer (transport inspector); and >> not lend or loan the Access Travel Pass to any other person. 5. The registered myki remains the property of the Public Transport Victoria. 6. Representatives of public transport authorities may inspect, deactivate, suspend, hotlist or take possession of the registered myki or require its return at any time if the pass holder is in breach of the terms of use. 7. A free replacement registered myki with a loaded Access Travel Pass will be issued if it becomes damaged and non-operational and when conrmed via a Statutory Declaration that the Access Travel Pass was lost or stolen. 8. Public Transport Victoria may change these terms of use from time to time. The current version of the terms of use may be obtained by contacting Public Transport Victoria on 1800 800 007 or by visiting ptv.vic.gov.au 9. Where Public Transport Victoria reasonably considers that any such change will have more than a minor detrimental effect on travel for pass holders generally, the change will be notied by Public Transport Victoria to pass holders in advance in writing. 10. Public Transport Victoria has the right to revoke, refuse to issue or reissue an Access Travel Pass to any applicant. 11. The entitlement enforced by the Access Travel Pass and established in the Victorian Fares and Ticketing Manual (myki) continues as long as the disability exists; therefore there is no need to reapply periodically for an Access Travel Pass. However, this is subject to any subsequent changes to the conditions governing the use of public transport. 18
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All other foreign languages 9321 5450 Submit completed form to: Public Transport Victoria Access Travel Pass applications PO Box 4724 Melbourne VIC 3001
PTVH0114
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