APPLICATION FORM YP15A

Save 3 - apply online at 16-25railcard.co.uk/leaet

IMPORTANT. Please complete the appropriate sections and boxes CLEARLY and in BLOCK CAPITALS.

(Please tick as appropriate)

Title* Mr Mrs Miss Ms Other Date of Birth D D M M Y Y Y Y Gender M F

First Name*

Surname*

Address*

Town*

Postcode* Telephone
inc. code

Mobile
Phone

Email is the most environmentally-friendly way for you to hear about Railcard news, renewals and all of our great offers.

Email address

Occupation School/FE student Part-time student HE/University student Mature student

Full-time employment Part-time employment Not in employment

*Must be completed.

RENEWALS
Are you renewing your
Yes No
existing Railcard?

Expiry date of
existing Railcard D D M M Y Y Y Y How many Railcards have you held in the past? Please continue overleaf

MATURE STUDENTS ONLY YP15A

All students aged 26 years and over, in full-time education must complete this section. Your tutor, head tutor, head of department or a University/College
administration staff member, needs to complete and sign below: I conrm that the applicant is a student attending University/College for over 15 hours per
week, for at least 20 weeks a year. I have signed and stamped the photo on the back.

University/College Stamp: Print name Signature

Position
Name of University/College
Telephone
inc. code

DECLARATION - TO BE COMPLETED BY ALL APPLICANTS

Before signing this declaration, it is important that you have read, understood and agree to the conditions shown in this leaet.
I have read, understood and agree to the conditions shown in this leaet. I conrm that the details I have provided are correct and that I am aged between
16 and 25 years or a mature student.
Signature* Date D D M M Y Y Y Y
*Must be completed.

On behalf of the Train Companies, ATOC Ltd collects and processes personal information for the purpose of sales analysis and market research.
ATOC Ltd is registered in the UK under the Data Protection Act 1998 as Data Controller. We will contact you when your card is close to expiry.*
From time to time your personal details may be used to send you relevant information as described below.
If you do NOT wish to be contacted for other marketing purposes please tick the relevant boxes.
I do NOT want to receive by Mail by Email by SMS
Railcard information and offers
Train Company offers and other rail-related services
We would also like to share your information with third parties so that they may send you information about their products and services.
If you do NOT want to receive this information by post, please tick here If you do want to receive this information by email or SMS, please tick here
*Provided we hold valid contact details.

FOR ISSUING OFFICE USE ONLY STATION OR TRAVEL AGENT STAMP:

New Railcard No:

Photocard No:

Date of Application: D D M M Y Y Y Y
Please dont forget to complete the Receipt section from a
Card Expiry Date: D D M M Y Y Y Y 16-25 Railcard leaflet available at your station.
Station/Agency NLC or Code No: Please return this form promptly. Refer to the online manual for details.