.......................... RAILWAY CM257

Reservation/Cancellation Requisition Form

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 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 giFve 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