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

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 penal 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 ____________________________  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.

 

 

 

 

Lower/Upper berth

 

Veg./Non-veg. Meal for Rajdhani/ Shatabdi Express Only

2.

 

 

 

 

3.

 

 

 

 

4.

 

 

 

 

5.

 

 

 

 

6.

 

 

 

 


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