Claim form

Page 1

WĂƐƐĞŶŐĞƌ ĐŽŵƉĞŶƐĂƟŽŶ claim form Passenger Details Title First Name

Claim Details Month

Surname

:ŽƵƌŶĞLJ ĨƌŽŵ

Address

Journey to Post Code

Year ZŽƵƚĞ EŽ͘

ŽŵŵĞŶƚƐ LJŽƵ ǁŝƐŚ ƚŽ ŵĂŬĞ͗

Phone (BH) Mobile Signature

Metcard Ticket Details Monthly

Six Monthly

Zone 1

Zone 1&2

Yearly

Please enter the 15 or 16 digit number

Ticket Expiry date Remember to enclose your expired monthly, six monthly Žƌ LJĞĂƌůLJ ƟĐŬĞƚ Žƌ Ă ƉŚŽƚŽĐŽƉLJ ŽĨ ďŽƚŚ ƐŝĚĞƐ ŽĨ ƚŚĞ ƟĐŬĞƚ ŝĨ LJŽƵ ĂƌĞ ƐƟůů ƵƐŝŶŐ ŝƚ͘

OR myki Card Details

Today’s date KĸĐĞ ƵƐĞ ŽŶůLJ Claim Number WůĞĂƐĞ ĐŽŵƉůĞƚĞ ƚŚŝƐ ĨŽƌŵ͕ ƉůĂĐĞ ŝŶ ĂŶ ĞŶǀĞůŽƉĞ ĂŶĚ ĂĚĚƌĞƐƐ ƚŽ͗ WĂƐƐĞŶŐĞƌ ŽŵƉĞŶƐĂƟŽŶ Yarra Trams Reply Paid GPO Box 5231 Melbourne VIC 3001 zŽƵ ǁŝůů ŶŽƚ ƌĞƋƵŝƌĞ Ă ƉŽƐƚĂŐĞ ƐƚĂŵƉ ŝĨ LJŽƵ ƉŽƐƚ ƚŚĞ ĐůĂŝŵ ǁŝƚŚŝŶ ƵƐƚƌĂůŝĂ͘

dŚŝƐ ϭϱ ĚŝŐŝƚ ĐĂƌĚ ŶƵŵďĞƌ ĐĂŶ ďĞ ĨŽƵŶĚ ŽŶ LJŽƵƌ ŵLJŬŝ͘ ZĞĂƐŽŶ ĨŽƌ ĐŽŵƉĞŶƐĂƟŽŶ͗ ŽŵƉĞŶƐĂƟŽŶ EŽƟĐĞ /ƐƐƵĞĚ ĞůĂLJ ŽĨ ŵŽƌĞ ƚŚĂŶ ϯϬ ŵŝŶƵƚĞƐ ǁŝƚŚŽƵƚ ďĞŝŶŐ ĂĚǀŝƐĞĚ ďLJ zĂƌƌĂ dƌĂŵƐ ŽĨ ƌĞĂƐŽŶ ĨŽƌ ĚĞůĂLJ ǁŚĞŶ on board a tram service WƌŽůŽŶŐĞĚ͕ ƐĞǀĞƌĞ ƐĞƌǀŝĐĞ ĚŝƐƌƵƉƟŽŶ ĂŶĚ ŶŽ ĂůƚĞƌŶĂƟǀĞ ƚƌĂŶƐƉŽƌƚ ŽƉƟŽŶƐ ĐŽŵŵƵŶŝĐĂƚĞĚ by Yarra Trams

zĂƌƌĂ dƌĂŵƐ ƵƐƚŽŵĞƌ &ĞĞĚďĂĐŬ ĂŶĚ ůŽƐƚ ƉƌŽƉĞƌƚLJ 1800 800 007 (6am–midnight daily) or visit yarratrams.com.au

z Z ϳϵϳϵ ϬϳͬϭϮ WƌŝŶƚĞĚ ŽŶ ƌĞĐLJĐůĞĚ ƉĂƉĞƌ͘ WůĞĂƐĞ ĚŝƐƉŽƐĞ ŽĨ ƚŚŝƐ ďƌŽĐŚƵƌĞ ƚŚŽƵŐŚƞƵůůLJ͘

myki Card number


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