Ateneo Gate Pass Sticker Application Form SY __________

Check applicable category ______ Student ______ Faculty ______ Administrator ______ Professional/Staff ______ Auxiliary/Affiliate ______ Business /Tricycle ______ Alumni/Visitor (Visito Ateneo ID No: _______________ Name __________________________________________ Unit: GS Primary School Grade & Section _____________ GS Middle School Grade & Section _____________ HS Year & Section _____________ LS Year & Course _____________ Other ________________________________________ New Sticker No: _____________ RMI No: _____________

check box if No:______________ Current Stickerapplicant/owner has NEVER been issued a sticker previously
(middle name) (last name)

Owners Name: _________________________________________________________________________________

(first name)

E-mail: _______________________________ Tel no.: _____________ Mobile phone:________________________ Home Address: _________________________________________________________________________________ Drivers Name: _________________________________________ Drivers License No. _______________________ LTO Car Registration No.: ________________________________ Date: ___________________________________ LTO Official Receipt No. : _________________________________ Date: ___________________________________ Make: _______________ Model: ___________ Year: _________ Color: _________ Plate No: ________________ Please read the Applicants Pledge below and the Campus Traffic and Parking Violations at the back and sign as indicated. Thank you.
APPLICANTS PLEDGE If my application is approved, I pledge to: 1. Ensure that my vehicle meets the exhaust emission standard as certified by a government accredited exhaust emission test center and to comply with periodic exhaust and road side emission tests as may be required on campus during the school year. 2. Ensure that a driver with a valid drivers license operates my vehicle. 3. Instruct the driver to strictly observe Ateneo traffic/parking rules and regulations. 4. Instruct the driver not to drink intoxicating liquor or gamble or engage in inappropriate behavior while inside the campus. Penalty P2000 5. Attach the gate pass sticker on the drivers side of the front windshield of my vehicle with the full knowledge that the gate pass sticker is non-transferable and specifically for the vehicle described above. 6. Promptly pay the P1000 penalty if the gate pass sticker is not attached to the windshield. 7. Pay the P3000 penalty if the gate pass sticker is used on another vehicle other than the one described above. 8. Promptly pay the fine for traffic and parking violations I or my authorized driver may commit; 9. Notify the University Physical Plant Office of a) change of license plate number, b) change of vehicle ownership, and c) vehicle repair or alteration. 10. Face possible administrative or disciplinary sanctions in the unit concerned in the event of multiple offenses committed within the fiscal year. I also acknowledge receipt of a copy of the Ateneo Traffic/Parking Rules and Regulations with the schedule of violation penalties. Signature of owner of vehicle: ________________________ Printed Name: ________________________
March 2012

Date: ________________________

ATENEO DE MANILA UNIVERSITY

Loyola Heights, Quezon City CAMPUS TRAFFIC & PARKING VIOLATIONS
March 26, 2012

TRAFFIC:
1. 2. 3. 4. 5. 6. 7. 8.

PENALTY P2,000 P1,000 P1,000 P3,000 P 500 P 500 P1,000 P1,000

Driving on campus without valid drivers license. Obstructing Traffic: Driving against the traffic or blocking traffic. Failure to give way to pedestrians on pedestrian lane. Reckless Driving: Violation of speed limit, disregarding traffic signs. Smoke Belching. Jaywalking. Driving vehicle on sidewalk & pedestrian walkway Loading or unloading at NO loading /unloading zones.

PARKING:
1. 2. 3. 4. 5. 6. 7.

Unauthorized parking/overnight parking on campus. Leaving vehicles unlocked while parked. Running the engine while parked. Parking in NO Parking zone. Parking on sidewalk and driveway. Parking in reserved areas. Improperly parked vehicle (vehicle occupying two parking slots).

P3,000 P1,000 P2,000 P1,000 P1,000 P1,000 P1,000

GATE PASS STICKER / PROXIMITY CARD: 1. Fake/altered gate pass sticker/proximity card. 2. Gate Pass Sticker/proximity card was used not for the vehicle for which it was issued. 3. Gate Pass Sticker not attached on the windshield. 4. Cars with sticker but no proximity card will be asked to park at Northwest Parking. OTHERS: 1. Discourtesy/verbal abuse towards other drivers, students, pedestrians, or traffic enforcer. 2. Vandalism, removal or defacement of street signs. P2,000 P1,000 P5,000 P3,000 P1,000 P 500

The Universitys traffic and parking rules are designed to create a safe environment for pedestrians, bicyclists and motorists, and to provide for the communitys daily transit needs. Please cooperate and help protect life and property. I agree to follow the Ateneo campus traffic and parking rules listed above and other policies that may be issued by the university from time to time and pay the corresponding fee when I violate any of the above rules. ____________________________________ Signature over printed name of vehicle owner

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