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 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
