RAILWAY RESERVATION / CANCELLATION REQUISITION FORM

If you are a Medical Practitioner Please tick ( ) in Box Dr. If you want Sr. Citizen concession, please write Yes/No in box penal charging under extant Railway Rules) Do you want to be upgraded without any extra charge? Write may be upgraded automatically) (You could be of help in an emergency) (if yes, please carry a proof of age during the journey to avoid inconvenience of

RAILWAY RESERVATION / CANCELLATION REQUISITION FORM

If you are a Medical Practitioner Please tick ( ) in Box Dr. If you want Sr. Citizen concession, please write Yes/No in box penal charging under extant Railway Rules) Do you want to be upgraded without any extra charge? Write may be upgraded automatically) (You could be of help in an emergency) (if yes, please carry a proof of age during the journey to avoid inconvenience of

Yes/No in the box. (If this option is not exercised, full fare paying passengers

Yes/No in the box. (If this option is not exercised, full fare paying passengers

Train No & Name: Class: Station From: Boarding At: S.No. Name in Block Letters (not more than 15 chars)

Date of Journey: No.of Berth / Seat: Station To: Reservation Upto: Sex (M/F) Age Concession / Travel Authority No. Choice if any

Train No & Name: Class: Station From: Boarding At: S.No. Name in Block Letters (not more than 15 chars)

Date of Journey: No.of Berth / Seat: Station To: Reservation Upto: Sex (M/F) Age Concession / Travel Authority No. Choice if any

Lower / Upper Berth

Lower / Upper Berth

Veg / Non-veg Meal for Rajdhani / Shatabdi Express only

Veg / Non-veg Meal for Rajdhani / Shatabdi Express only

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

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

S.No.

Name in Block Letters

Sex

Age

S.No.

Name in Block Letters

Sex

Age

ONWARD / RETURN JOURNEY DETAILS

ONWARD / RETURN JOURNEY DETAILS

Train No & Name ____________________________________ Date ______________________________ Class ________________ Station From _______________________ To ___________________________ Name of Applicant ______________________________________________________________________ Full Address ___________________________________________________________________________ Telephone No: ___________________________Date ______________________ Time _______________

Train No & Name ____________________________________ Date ______________________________ Class ________________ Station From _______________________ To ___________________________ Name of Applicant ______________________________________________________________________ Full Address ___________________________________________________________________________ Telephone No: ___________________________Date ______________________ Time _______________

Signature of the Applicant

Signature of the Applicant

FOR OFFICE USE ONLY

FOR OFFICE USE ONLY

S.No. of Requisition__________________________ PNR No.____________________________________ Berth/Seat No.______________________________ Amount Collected ____________________________

S.No. of Requisition__________________________ PNR No.____________________________________ Berth/Seat No.______________________________ Amount Collected ____________________________

Signature of Reservation Clerk

Signature of Reservation Clerk

Note: 1. Maximum permissible passengers are 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.

Note: 1. Maximum permissible passengers are 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.