ARRIVA ANNUAL TICKET APPLICATION FORM
Please ensure you complete the entire form to take advantage of the travel
ticket loan scheme.
Please print in BLOCK CAPITALS.
Title: ..……. First Name:
……………………………………………………
Surname: ………………………………………… Personnel no: …………………
School/Service: ……..…………………………………………………
Home Address: ………………………………………………………………….
…………………………………..
Date of birth : ………………………
Post code: ……………………
Telephone ext: …………….
E-mail address: …………………………………..…..
ARRIVA TICKET DETAILS
Tickets commence on the 1st of the month
Zones required:
(Please tick as many zones as required)
Northumberland Triple 1 zone

590.00
County Durham

590.00
Tees Valley

590.00
Northumberland Triple 2 zone

899.00
Full region

995.00
Please state required month: ……………………
Your smartcard photo will be used for your travel pass, unless a passport photo is
enclosed.
-------------------------------------------------------------------------------------------------------------I hereby apply for a corporate travel loan and give authority below to deduct the appropriate
charge from my salary.
SALARY DEDUCTION AUTHORISATION
Signature
…………………………………
Date ………………………….
Amount
£………………………………..
If on fixed term contract, please indicate contract end date: ………………………..
Please select preferred payment method from options below

One lump sum payment (deducted from salary)

Monthly instalment
(deducted from salary)
In the event of leaving the University, any outstanding balance on the travel loan will be
deducted from final salary.
Please return completed application to Christine Cairns, Estate Support Service, 1st
floor Agriculture Building (email: christine.cairns@ncl.ac.uk).
------------------------------------------------------------------------------------------------------OFFICE USE ONLY
Commencement Date …………………
Renewal Date
…………………
Travel card type:
Cancel Date
…………………