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RAILWAY
CM257
RESERVATION/CANCELLATION REQUISITION FORM
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If you are
a Medical Practitioner Please tick ( ) in Box
(You could be of
help in an emergency) |
Dr.  |
If you want Sr. Citizen concession, please write Yes/No in box (if yes, please
carry a proof of
age during the journey to avoid inconvenience of penal charging
under extant Railway Rules)
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Do you want to be
upgraded without any extra charge? Write
Yes/No in the box.
(If this option is not exercised, full fare paying passengers may be
upgraded automatically) |
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Train No &
Name ___________________ Date of journey______________________
Class ____________________________ No of Berth/Seat_______
Station from _______________________ To __________________
Boarding at ______________________ Reservation upto
_____________________
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S.No.
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Name
in Block letter(not more than 15 chars)
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Sex(M/F)
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Age
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Concession/TravelAuthority No.
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Choice
if any
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1.
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Lower/Upper berth
Veg./Non-veg. Meal for Rajdhani/ Shatabdi Express Only
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2.
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3.
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4.
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5.
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6.
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CHILDREN BELOW 5 YEARS (FOR
WHOM TICKET IS NOT TO BE ISSUED)
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S.No.
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Name
in Block Letters
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Sex
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Age
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ONWARD/RETURN JOURNEY DETAILS
Train No. & Name________________________ Date
________________________
Class ________ Station from:___________________
To________________________
Name of applicant _______________________________________________________
Full Address ___________________________________________________________
______________________________________________________________________
Signature of the Applicant/Representative
Telephone No., if any
_______________________ Date __________Time __________
FOR OFFICE USE ONLY
S.No. of Requistion_______________________
PNR No._______________________
Berth/Seat No._______________ Amount collected _____________________________
_________________________
Signature of Reservation
Clerk
Note :
1.Maximum permissible passengers is 6 per
requisition.
2. One
person can give one requisition form at a time.
3. Please
check your ticket and balance amount before leaving the window.
4. Forms
not properly filled or in illegible forms shall not be entertained.
5. Choice
is subject to availability
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