Required fields are marked with asterisks (*)

Veteran Transit Pass Application

I confirm that I am a City of Belleville resident (Ward 1)

Yes

Applicant Information

First name

Last Name

House or 911 number:

Apt. or unit #:

City

Postal Code

Primary Phone Number

Secondary Phone Number

E-Mail Address

Date of Birth:

Emergency Contact

Name:

Relationship:

Phone Number:

Veteran Eligibility

I confirm that I am a Canadian Armed Forces veteran and meet the eligibility requirements for the Veteran Transit Pass.

Yes

Acceptable Proof of Veteran Status (indicate which ID you will provide):

Canadian Armed Forces Veteran Service Card

CF1 Card

Veterans Affairs Canada (VAC) Identification

Other official veteran documentation

Please upload proof of Veteran Status

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Terms & Conditions of Use:

The Veteran Transit Pass is valid for 10 years from the date of issue and entitles the cardholder to unlimited travel on regularly scheduled Belleville Transit conventional services. Use on Mobility Bus services is permitted only for individuals who are registered and approved for Mobility Bus eligibility in accordance with Belleville Transit policies.

I understand this pass is for my personal use only.
I understand misuse may result in suspension or cancellation of the pass.
I understand eligibility may be reviewed periodically.
I acknowledge this program is subject to change or cancellation by the Municipality

APPLICANT DECLARATION

I hereby certify that to the best of my knowledge, the information given above is correct and understand the Terms and Conditions of Use.

Signature of Applicant or Designate

Clear

Date