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.......

....................... 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)

Train No & Name ___________________ Date of journey______________________

Class ____________________________ No of Berth/Seat_______

Station from _______________________ To __________________

Boarding at ______________________ Reservation upto _____________________

S.No.

Name in Block

letter(not more than 15

chars)

Sex(M/F)

Age

Concession/TravelAuthority

No.

Choice

if any

1.

2.

3.

4.

5.

6.

Lower/Upper

berth

Veg./Non-

veg. Meal for

Rajdhani/

Shatabdi

Express Only

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

S.No.

Name in Block Letters

Sex

Age

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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