Railway Reservation Form

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&nbsp........................RAILWAY&nbspCM257
RESERVATION/CANCELLATION REQUISITION FORM
IfyouareaMedicalPractitionerPleasetick()inBox(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 penal charging under extant Railway Rules)
Doyouwanttobeupgradedwithoutanyextracharge?WriteYes/No in the
box. (If this option is not exercised, full fare paying passengers may be upgraded
automatically)

TrainNo&Name___________________Dateofjourney______________________
Class____________________________NoofBerth/Seat_______
Stationfrom_______________________To__________________
Boardingat______________________Reservationupto_____________________
S.No. Name in Block letter(not more
than 15 chars)
Sex(M/F) Age Concession/TravelAuthority
No.
Choiceifany
1.



Lower/Upper berth
Veg./Non-veg.
2.



Meal for Rajdhani/
Shatabdi Express
Only
3.



4.



5.



6.



CHILDRENBELOW5YEARS(FORWHOMTICKETISNOTTOBEISSUED)
S.No.
Name in Block Letters
Sex
Age








&nbsp&nbspONWARD/RETURN JOURNEY DETAILS
TrainNo.&Name________________________Date________________________
Class ________ Station from:___________________ To________________________
Name of applicant _______________________________________________________
Full Address ___________________________________________________________
______________________________________________________________________
&nbsp&nbspSignature of the Applicant/Representative
TelephoneNo.,ifany_______________________Date__________Time__________
&nbsp&nbspFOR OFFICE USE ONLY
S.No. of Requistion_______________________ PNR No._______________________
Berth/Seat No._______________ Amount collected _____________________________
&nbsp&nbsp&nbsp&nbsp_________________________
&nbsp&nbsp&nbsp&nbspSignatureofReservationClerk
Note:1.Maximumpermissiblepassengersis6perrequisition.
2.Onepersoncangiveonerequisitionformatatime.
3.Pleasecheckyourticketandbalanceamountbeforeleavingthewindow.
4.Formsnotproperlyfilledorinillegibleformsshallnotbeentertained.
5.Choiceissubjecttoavailability