Includes the main applicant and any persons (adults and children) who live in the same dwelling and are related by blood, marriage, common-law union, adoption or a foster relationship.
Please note, if you or anyone in your household:
One of the following must be submitted for each applicant over the age of 18.
Privacy Notification Statement
We are collecting your personal information under the authority of the City of Winnipeg Charter Act. This information will be used to administer Winnipeg Transit's Low Income Transit Pass Program and will not be used or disclosed for any other purposes, except as authorized by law. If you have any questions about the collection, use, or disclosure of your information, contact the Corporate Access and Privacy Officer by mail (City Clerk's Department, 510 Main Street, Winnipeg, R3B 1B9) or by telephone at 311.
Applicant(s) (Must be signed by all household members over the age of 18)
I declare that the information provided in this application is true and complete to the best of my knowledge. I declare that I have completed this application at the request of the applicant(s) and that I am willing to be contacted on their behalf if clarifications or further communications are required for processing this application.
Please use this space to add any additional details or comments that may affect your eligibility.
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