2015.9.21 Ver.

Senior Citizen Card (Over 65 years old) (Please return the old card if you have one; counter application is advised.)
Disabled Card (With disabled brochure or certificate) (Please return the old card if you have one; counter application is
advised.)
Accompany Card (Complied with the application qualifications)
Taoyuan Citizen Card Application Form General Card (For citizens over 7 years old and does not comply with other application qualifications, immigrants and foreign
spouses.)
Easy Card Application
iPASS Application Student Card without function of student certificate: Students who registered in Taoyuan city but study outside Taoyuan City, please fill out
the Taoyuan Citizen Card Application Form (Student Card without function of student certificate).
Apply for (replace or reissue) student cards with student certificate should firstly consult with the register office at school.

Columns marked with * must be filled out for fear of failure of application (The information below should be written in block letters and with full details)

*Name *Gender Male Female

(Photo)
*ID 1. General card does not require photo.
(Resident *Date of 2. Senior Citizen Card, Disabled Card
Certificate Birth and Accompany Card application
should be submitted with one front,
Number) half-length, 2-inch colored photo
Mobile taken within six months. If there is
special condition and approval by
*Phone Number Phone the unit, it could be applied without
Number photo.
3. Write down name and ID number on
the back of the photo
Email Address
*Application First Issued Replace (Reissue) the Photo Print No Yes
Item Card (for general card)
*Household
Address Taoyuan City District Village Neighborhood Rd./Street Sec. Lane Alley
(Same with the ID
card) No. F. of___
The same above Township Village
*Contact
_____City District Village Neighborhood Rd./Street Sec. Lane Alley No.
Address
F. of___
Receive promotion information from designated stores cooperated with Citizen Card
Email address should be written down to provide designated stores for delivering promotion information.
NoteColumns marked with* must be filled out (The above information should be written in block letters and
with full details)
* Required certificate copy (front) paste
1. General card and senior citizen card require ID
* Required certificate copy (Back) paste
1. General card and senior citizen card require ID
copy (for immigrants and foreign spouses, paste the
copy (for immigrants and foreign spouses,
resident certificate and the spouses ID (or
paste the resident certificate and the spouses
household certificate/ household certificate
ID (or household certificate)).
transcription)).
2. Disable card requires disabled brochure or
2. Disable card requires disabled brochure or
certificate copy.
certificate copy.
3. Commissioner should scan the applicant's ID
3. Commissioner should scan the applicant's ID and
and upload to the system.
upload to the system.

I hereby agree with nominative electronic ticket issued by Taoyuan City Government and Easy Card/iPASS Corporation, and enjoy the
service of reporting loss and money returns.
I hereby agree to provide the above personal information to Taoyuan City Government for related service of citizen card and statistics
analysis and service of Easy Card/iPASS Card Co. as nominative card, and I have confirmed that all the information is correct.
I hereby agree with the above conditions and have read thoroughly the Taoyuan City Government Personal Information Collection
Notification and Easy Card Co. Collection and Personal Information Usage Notification Item, and content of iPASS Co. personal
information collection, analysis, utilization notification item. Signature as confirmation as follows (Applicants under 18 years old
should entrust legal representative to sign).
Applicant (or legal representative)(Signature)
Application Date: Y M D
(Applicant who commission others to apply: Commissioners should bring ID card for checkup and fill out the
letter of attorney as follows)
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Letter of Attorney
Applicant could not apply the card in person and with trustee brings the related required documents and the
letter of attorney on the behalf of applicant to apply the card. If this statement is not true, the applicant will bear
all legal responsibilities.
To Taoyuan City Government Applicant (Signature)

Trustee (Signature) ID Number

Address of TrusteeTaoyuan City District Village Neighborhood Rd./Street Sec. Lane Alley
No. F.
Contact Number