Application for Home to School Transport - Concessionary Seats

Please read the Concessionary Seats Guide for Parents before completing this form. This can be found at www.durham.gov.uk/concessionaryseats

Academic Year

Are you applying for transport for now or for next September? Please choose the appropriate academic year from the drop down list below:*

You can renew your application automatically, so you do not need to re-apply every year.

Only apply for a single year:* Yes No

Which school is the pupil attending?

School:*

Concessionary Scheme:*

Proof of Eligibility:*

Browse Upload evidence

Route/Bus Stop Details

First Preference

Route:*

Other route:*

Stop:*

Other stop:*

Second Preference

Route:*

Other route:*

Stop:*

Other stop:*

Pupil Details

First name:*

Last name:*

Please enter the pupils address and choose the correct entry from the list:*

Date of birth (dd/mm/yyyy):*

Gender:* Female Male

Year group:*

Pass type:*

Invoice Payee Details

Note: this person must be over 18 years old.

Title:*

First name:*

Last name:*

Is the invoice payee address the same as the pupils address?* Yes No

Please enter the invoice payee address and choose the correct entry from the list:*

Email:*

Telephone number:*

Relationship to pupil:*

Direct Debit

Would you like to pay by direct debit?* Yes No

Can you confirm you that you hold a UK bank/building society account and that you are the account holder?* Yes No

Can you confirm that you are the only person required to authorise debits from this account?* Yes No

Are the direct debit account holder details the same as the invoice payee details?* Yes No

Name of account holder:*

Email address of account holder*:

Contact telephone number of account holder:*

Account holder address line 1:*

Account holder address line 2:

Account holder address town:*

Account holder address postcode:*

Bank/building society account number:*

Branch sort code (XX-XX-XX):*

Building society reference number:

Direct debit guarantee

This guarantee is offered by all banks and building societies that accept instructions to pay direct debits.
You can cancel a direct debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.

Declaration

I agree to be invoiced for the cost of the seat for the pupil above. I have read and accept the terms and conditions of the Concessionary Seat scheme in the Guide for Parents document.

Do you agree?:* Yes

Application for Home to School Transport - Concessionary Seats

Academic Year

Which school is the pupil attending?

Route/Bus Stop Details

First Preference

Second Preference

Pupil Details

Invoice Payee Details

Sibling Subsidy Scheme

Sibling 1

Sibling 2

Sibling 3

Financial Assistance Scheme

Parent/Carer 1 Within The Household

Parent/Carer 2 Within The Household

Direct Debit

Declaration

Application for Home to School Transport - Concessionary Seats

Application for Home to School Transport - Concessionary Seats