Reservation Form

........................ RAILWAY CM257
RESERVATION/CANCELLATION REQUISITION FORM

If you are a Medical Practitioner
Please tick ( ) in Box Dr.
(You could be of help in an emergency)

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 panel charging under extant Railway Rules)

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)

Train No & Name Date of journey

Class                                                 Number of Berth/Seat
Station From To

Boarding at     Reservation upto

S.No.	Name in Block Letters (not more than 15 letters)	Sex (M/F)	Age	Concession/Travel Authority No.	Choice (Lower/ Upper Berth)	Meals for Rajdhani/Shatabdi Express
1.
2.
3.
4.
5.
6.

CHILDREN BELOW 5 YEARS (FOR WHOM TICKET IS NOT TO BE ISSUED)

S.No.

Name in Block Letters (not more than 15 letters)

Sex

Age

1.

2.

                                               ONWARD/RETURN JOURNEY DETAILS
Train No & Name                                Date of journey

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