Concessionary Travel Printable application form

Please read the Concessionary Travel Information Page carefully before completing and sending your application.

Who is Eligible?

You must be a permanent resident in the Borough of Telford & Wrekin and must fall into ONE of the following categories:

Please tick all below that apply to you:

Age eligible and over from 6th April 2010 the age of eligibility for concessionary travel for women will be pension age and for men it will be the pensionable age of a woman born on the same day. Visit for further details or you can call 01952 383867.

Registered blind or partially sighted

Registered profoundly or severely deaf and/or without speech

Someone who does not have arms or has long term loss of the use of both arms

Someone who has a disability or injury which has substantial and long-term adverse effect on their ability to walk

Someone who has a learning disability, that is, a state of arrested or incomplete development of mind, which includes significant impairment of intelligence and social functioning

In receipt of a letter from the Department of Transport withdrawing or refusing a driving licence on medical grounds and that it is not due to drug or alcohol abuse/dependency

In receipt of a letter from your Doctor stating what your medical condition is and that it is not due to drug or alcohol abuse/dependency.

In possession of a disabled persons parking badge (Blue Badge)

Receive one of the following benefits:

Disability Living Allowance with Mobility component at Higher Rate

Personal Independent Payment (PIP) 8 points or more of the “moving around” and/or “communicating verbally” activities

Industrial Injuries Disability Benefit or reduced earning allowance

War Pensioners Mobility Supplement (WPMS)

Carers Allowance in payment to your carer. (Award of this entitles your companion/carer to travel with you. This is required in addition to any of the above and on its own does not merit award of the travel pass.)

You will be required to provide proof of eligibility

Title ______Surname ______

First Names(s) ______Date of Birth ______

Address ______

______

Post Code ______Telephone No. ______

Signature: ______Date: ______

Please tick ONE option that you wish to receive. Please note that by choosing an alternative option you will give up your right to choose the English Concessionary Travel Pass for a period of 12 months. However you may be entitled to the Dial-A-Ride scheme along side your Concessionary Travel Pass please contact the Team for further information.

If you wish to register for the Dial a Ride service, please print and complete the Dial a Ride application form. (£2.00 charge to apply for scheme)

English Concessionary Travel Pass No Cost

Disabled Person’s Rail Card the subsidised annual cost is £10.

Please see details below of First Point offices you can attend and their opening times. Please note that the last enquiry will be processed half an hour before the Library closes.

Southwater Library, 1st Floor, Southwater One, Southwater Square,Southwater Way,Telford, TF3 4JG / Monday to Friday 10am – 5pm
Saturday 10am – 1pm
Sunday 11am – 4pm
Wellington Library, First Point,
Wellington Civic and Leisure Centre, Larkin Way, Wellington, TF1 1LX / MondayTuesday 10am – 5pm
Wednesday – Closed (self-service only)
Thursday to Saturday 10am – 5pm
Madeley Library, First point
21 Russell Square, Madeley, Telford, TF7 5BB / Monday Tuesday 10am – 5pm
Wednesday - Closed
Thursday 10am – 5pm
Friday - Closed
Saturday 10am – 1pm
Newport Library, First Point
53-55 High Street, Newport, Telford, TF10 7AT / Monday Closed
Tuesday & Wednesday 10am – 5pm
Thursday Closed
Friday 9am – 4pm
Saturday 10am – 1pm

First point action taken:

Age Application and YES
Proof checked & updated
On Unicard / Record Unicard account number:

Disability proof checked YES
and photocopied NO
send paper work to
Addenbrooke House for actioning / Record Unicard account number:
Actioned by Concessionary Officer:
Name: Date:
First Point Officer: / First point Location:
Date:

Monitoring sheet

The information provided on this sheet is for the collection and analysis of statistical data. By signing the application form you acknowledge and agree to Telford & Wrekin Council holding and processing data in this way.

Please tick all relevant boxes

Gender / Male  / Female
Ethnic Origin / Bangladeshi  / Pakistani / Indian
Black African  / Black Caribbean / Chinese
White & Black Caribbean  / White & Black African
White Asian  / White Irish / White British
Other 
Disability: / Yes  / No

If yes, please give details:

Notice under the Data Protection Act 1998
The Council processes data in accordance with the principles of good information handling contained in the Data Protection Act 1998. We will not sell this information to any other persons or organisations; however, the data collected may be used to provide you with information about the services offered by the council. If you do not wish the Council to use your data in this way please tick the box.
Telford and Wrekin Council is under a duty to protect funds it administers, and to this end may use the information you have provided on this form for the prevention and detection of fraud. It may also share this information with other bodies responsible for auditing or administrating public funds for these purposes.
For further information, or contact Information Governance Team Leader on 01952 383103 by emailing

Concessionary Travel. Revenue & Benefits Service PO Box 249, Addenbrooke House Telford, TF3 4NT