Concession Form

Which concession are you applying for?

Select one

Over 60s Travel Pass

English National Concessionary Travel Pass When you have reached State Pension Age

Disabled Persons’ Travel Pass A disabled persons concessionary bus pass

What do you want to do?

Select one

Apply for a new pass

Renew my pass

Your information

All applicants must fill in this section

First name(s)required

Last namerequired

Date of birthrequired

Year

Month

S	M	T	W	T	F	S

Email addressrequired

Confirm email addressrequired

Contact phone numberrequired

Carer / Guardian phone number

Address

Address line 1required

Address line 2

Address line 3

Address line 4

Postcoderequired

Select the category you are applying under
(please select one only)

Select one

Category A I am blind or partially sighted

Category B I am profoundly or severely deaf

Category C I am without speech

Category D I have severe difficulty walking

Category E I have lost the use of both arms

Category F I have a learning disability

Category G I am unable to drive for medical reasons

Upload your photograph

Please make sure that your photograph meets our digital standards. If your photograph is unsuitable, your application may be delayed and cannot be processed until we receive a suitable photograph:

Your photograph must be:

recent
colour
passport size
showing your full face without a hat
good quality
taken against a white or pale background

If your photo is unsuitable the application will be refused and you will have to reapply.

Drop your files here or click ‘Upload’

Upload

File type JPG only
Max size 10MB

Upload proof of where you live

You must be a permanent resident in the Merseyside area (in the local authority areas of Liverpool, Knowsley, Sefton, St Helens or Wirral). Click here to see if your address is within Merseyside. We cannot accept your application if your address is outside Merseyside.

You must provide photographic proof of your address to confirm that you are a permanent resident within the Merseyside area. It must be dated within the last 12 months. We will accept the following:

Council Tax Bill or
Utility Bill or
Bank Statement or
A similar bill which shows your name and address.

Drop your files here or click ‘Upload’

Upload

File types JPG or PDF only
Max size 10MB

Upload proof of your age / identity

To apply online you must be able to provide proof of age and photo identification. We only accept the following:

A copy of your passport clearly showing your photo or
A copy of your photo card driving licence or
A copy of your Identity Card or
A copy of your Asylum Card

Don’t have any of this information?

If you do not have any photographic proof of age, you will need to take your Birth Certificate and apply in person at one of our Merseytravel Centres. For details of all our locations and opening times please click here.

Drop your files here or click ‘Upload’

Upload

File types JPG or PDF only
Max size 10MB

Disability category evidence

Your supporting evidence must be dated within the last 12 months. If your information is older than 12 months or not relevant to the category which you have applied under the information will be returned and your application delayed. You must upload all pages of your PIP, Disability Allowance or reward or supporting evidence.

Category G evidence

Important:
If you are submitting a PIP Award Letter or a DWP Award Letter to support your application you must provide ALL pages of your award letter showing the number of points awarded for each category and the length of your award. There must be at least 6 months remaining on your award. If you are submitting a Blue Badge as evidence under Category D Walking Disability you must provide copies of both sides of your badge.

Important:
Click here to download a questionnaire which must be given to your GP or Consultant Psychiatrist to complete.

Download questionnaire

Drop your files here or click ‘Upload’

Upload

File types JPG or PDF only
Max size 10MB

Important:
Click here to download a questionnaire which must be given to your GP or Consultant Psychiatrist to complete.

Download questionnaire

Evidence of your benefits

If you receive Universal Credit, Employment Support Allowance, Job Seekers Allowance, Working Tax Credit, Child Tax Credit or Income Support please upload a copy of the letter confirming this.

Drop your files here or click ‘Upload’

Upload

File types JPG or PDF only
Max size 10MB

Declare and sign

Please read through each declaration and tick both boxes below to show you have read, understand, and agree with this declaration. Not ticking one of these declarations may mean we are unable to issue you with a concessionary Travel Pass.

I confirm that, as far as I know, the details I have provided are complete and accurate.

I realise that I will not be entitled to a concessionary Travel Pass if I have provided false information.

I confirm that the photograph I have provided is a true likeness.

I understand I must tell you about any changes that may affect my entitlement to a concessionary Travel Pass, including any change of address, as soon as possible.

I understand that you will deal with all documents relating to this application in line with General Data Protection Regulations and you may share them with other local authorities and the police to detect and prevent fraud.

From time to time we (or agents acting on our behalf) may contact you for customer research or to send you extra information which may be of interest to you.If you want us to contact you, please tick the box.

I can confirm that I have read all the above information and I am aware that misuse of any concession which is issued or providing false information may lead to prosecution.

I agree with the terms and conditions of the scheme and Merseytravel Fair Processing policy in relation to GDPR and Data Protection

Signature

Print your name in this box.required

Relationship to applicant if applicable

By typing your name electronically in the signature box on this application form you agree, acknowledge and intend that this will constitute your signature for the purposes of this application.