Karnataka State Road Transport Corporation

          ( Application for Student Bus Pass )

Application Number: SP00455057 Affix the photograph attested by

the Head of the Institution
Name of the student: MANOJ KARABASAPPA ARALI

Father's Name: KARABASAPPA

Date of birth: 27-12-2002

Gender: Male

Aadhaar Number : 887124465732 Category : General/OBC

E-mail ID : santoshbn95@gmail.com Mobile Number : 8861869055
Permanent Address : HEDIYALA HEDIYALA, HEDIYALA, RANIBENNUR, HAVERI, KARNATAKA-581208
Temporary Address :
Education Details
Education : PUC/Degree/Diploma Class : 1st year Education Institution Name : BAJSS PU COLLEGE RANEBENNUR
Education Institution Address : INDHIRA NAGAR RANIBENNUR HAVERI, RANIBENNUR, RANNEBENNUR, HAVERI, KARNATAKA-581115
School/College fee Receipt number : 963 Fee paid date : 31-07-2019
Pass Route
From : HEDIYALA To : RANIBENNUR Route change place : HALAGERI

   I will not misuse this pass.

Parent/Guardian Signature
Student Signature
Date:

Con rmation from Educational Institution

The above information is correct. It is certified that students’ personal details mentioned above are as recorded in our Education Institution.

Student Registration No.:…………………………………………..

School/College/University Seal
Principal/Head Master/ Head mistress Signature
Date:

For o ce use only

Pass / Card No..............................................................................

Validity of pass From:........................................... To ....................... ................

Chargeable stages .......................................................................... ...............