Replacement myki Form

Replacement myki
Form
Use this form if you need to replace
a registered myki that is lost, stolen
or not working.
If you are deaf, or have a hearing or speech impairment,
contact us through the National Relay Service:
•TTY users phone 133 677, then ask for 1800 800 007.
•Speak and listen users phone 1300 555 727, then ask for
1800 800 007.
For more information about myki
Visit ptv.vic.gov.au
Call 1800 800 007
If you need an interpreter:
• Call the Translating and Interpreting Service (TIS National) on 131 450 and ask for 1800 800 007.
Post this form with your myki (unless lost or stolen) to
myki Mailbox
Reply Paid 4318
MELBOURNE VIC 8060
(No stamp required)
Please allow up to 10 business days to receive your new card if
posting this form.
PTV 7541/13
Or lodge this form with your myki (unless lost or stolen) at
• The PTV Hub at Southern Cross Station.
General Information
How to obtain a replacement myki
You should use this form when obtaining a replacement
myki. Your replacement myki must be the same type as
your original myki (e.g. full fare, child, concession, senior).
If your myki is not working:
Complete this form and post it to the myki Mailbox with
your myki or lodge it in person at the PTV Hub at Southern
Cross Station. Your replacement myki will be sent to you
within 10 business days of receiving your application. Until
your replacement myki arrives, please use another myki to
travel. This myki can be kept as a spare and used by family
or friends as and when needed.
The table below shows whether you are eligible to apply
for a replacement myki.
Your original myki is:
Unregistered
Registered
Not working
3
3
Lost/stolen
X
*
^
3
* If your myki is not registered, you cannot apply for a
replacement myki if it is lost/stolen. You must purchase
a new myki.
^ If your myki is registered, you must report it lost/stolen
immediately by visiting ptv.vic.gov.au or calling
1800 800 007 to protect your myki balance.
Please submit your myki (unless lost or stolen)
with this form.
If your myki holds a myki pass, it will be suspended from
the time you report it as lost or stolen, or when we receive
this form. Once your pass has been transferred to your
replacement myki, your myki pass will start again the next
time you touch on.
If your myki has myki money on it, we will automatically
transfer the remaining value to your replacement card.
If your current myki is registered, your replacement
myki will be automatically registered. Any existing top up
arrangements will be transferred to your new myki card.
If your current myki is personalised, your replacement
myki will automatically be personalised.
Do not use this form if you require a new myki because
your travel entitlement has changed (e.g. if you are no
longer entitled to a concession myki and need to obtain
a full fare myki instead). You will need to purchase a new
myki with the correct travel entitlement. You can then
complete a Refund & Reimbursement Form to apply for a
refund of the balance of your original myki.
Important note for students
Do you require a replacement Student Pass? You must
return to the location where you originally obtained the
Student Pass to lodge this replacement application.
Important note for Free Travel Pass holders
If you require a Replacement Travel Pass, please contact
the PTV Hub at Southern Cross Station.
Visit ptv.vic.gov.au or call 1800 800 007 if you require
further copies of this form.
If your myki is lost or stolen:
If your registered myki has been lost or stolen, please report
it immediately at ptv.vic.gov.au or by calling 1800 800 007 to
guarantee balance protection.
When and how will I receive my replacement myki?
You will receive your replacement myki in the mail. Any
remaining myki money and/or myki pass days will be
transferred to your new myki, so it’s ready for use when
it arrives.
If you lodge this form at the PTV Hub at Southern Cross
Station, your remaining balance will be transferred to your
replacement myki once the form is processed. Please note
that the transfer may take up to 10 business days.
Application for Replacement myki Form
How to complete this form
• Place a cross X within the appropriate box when selecting an option.
• Please use BLACK INK and print within the boxes using CAPITAL LETTERS.
If posting this form, please allow up to 10 business days for processing and/or delivery. If your old myki was registered, then your
new myki will be automatically registered when this form is processed.
Is your registered myki lost or stolen?
Report it immediately at ptv.vic.gov.au or by calling 1800 800 007 to guarantee balance protection. Then complete and lodge this
form to receive your replacement myki as soon as possible.
Section A: Customer Details
Cardholder Details (Please complete)
Title (Mr, Mrs, Miss, Ms, other)
Given name
Family name
If your myki was not registered, please skip to Postal Details.
Account Holder Details (The person who manages the registered myki of the cardholder)
Title (Mr, Mrs, Miss, Ms, other)
Given name
Family name
Postal Details
Unit number
Street number
PO box number
Street name
Suburb/town
State
Postcode
Contact Details (Please provide at least one telephone number)
Daytime phone number (with area code)
Mobile number
Email address (Please complete using CAPITAL LETTERS. If the email address is too long for one row of boxes please make use of the second row provided)
Preferred Method of Contact (Please choose at least one)
Telephone
FPR-M-003-W
Email
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Section B: Applying for a Replacement myki
Card number of myki to be replaced (if known)
The 15-digit card number can be found on your myki.
PLEASE SUBMIT YOUR MYKI WITH THIS FORM, UNLESS IT IS LOST OR STOLEN.
Reason for replacement
Damaged /defective
Lost
Stolen
What date did your myki become damaged/defective/lost/stolen?
Date
YOU CANNOT APPLY FOR REPLACEMENT OF AN UNREGISTERED MYKI IF IT IS LOST OR STOLEN. YOU MUST PURCHASE A NEW MYKI.
Section C: Credit Card Details
Administration fees were abolished as of 1 January 2012. There is no need to provide your credit card details when applying
for a replacement myki.
Credit card type
Visa
MasterCard
Name on credit card
Credit card number
Expiry date on credit card
Signature of credit card holder
Date
Section D: Privacy Notice and Declaration
The account holder or cardholder (‘you’) will generally be able to access your personal information. If personal information sought by
Public Transport Victoria (PTV) (‘we’ or ‘us’) is not provided, we may not be able to fulfil your request. For further information about privacy
and on rights of access to personal information, visit ptv.vic.gov.au or call 1800 800 007.
Unregistered cards: Personal information you provide is collected by or on behalf of Public Transport Authorities# for the purpose of fulfilling
your request, and will be used and disclosed only for this purpose.
Registered cards: Personal information provided by or about you or generated by using the Card is collected by Public Transport Authorities#
to issue and administer the Card and relevant entitlements.
Personal information held by Public Transport Authorities# may be used or disclosed (including to each other) for the operation of myki, to
verify entitlement to concession travel, for ticketing enforcement, in emergencies, otherwise as required or authorised by or under law, or
with your consent. A cardholder’s personal information may be disclosed to an account holder.
#
ublic Transport Authorities means PTV, the Department of Transport and any agent, contractor or delegate of PTV or the Department of Transport
P
including public transport operators.
I apply for a replacement myki and declare that the information I have given on this form is true.
I have read the Privacy Notice.
Signature
Date
FPR-M-003-W
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Section E: myki Office Use only
Date
Location of lodgement
Name of staff member
Reason for replacement application
Damaged
Defective
Lost
Stolen
myki replaced
Yes
No
Replacement myki PAN
Yes
No
Technical failure type (Kamco Office Use Only)
Chip
Card body
Graphic
Antenna
Other
Section F: Replacement myki Customer Receipt
Customer, please separate and retain. Enquiries: please call 1800 800 007.
Damaged or defective myki card number
The 15-digit card number can be found on your myki.
Date
FPR-M-003-W
Location of lodgement
Page 3 of 3