Eastern Railway CM257 Eastern Railway CM257

RESERVATION/CANCELLATION REQUISITION FORM RESERVATION/CANCELLATION REQUISITION FORM

If you are a Medical Practitioner Please tick in Box Dr. If you are a Medical Practitioner Please tick in Box Dr.
If you want Sr. Citizen concession, please write Yes in box If you want Sr. Citizen concession, please write Yes in box
Do you want to be upgraded without any extra charge? Write Yes/No in the box. Do you want to be upgraded without any extra charge? Write Yes/No in the box.

Train No & Name _________________________________________ Date of journey__________________________ Train No & Name _________________________________________ Date of journey__________________________
Class ___________________________________________________ No of Berth/Seat_________________________ Class ___________________________________________________ No of Berth/Seat_________________________
Station from _________________________________________ To _________________________________________ Station from _________________________________________ To _________________________________________
Boarding at _______________________________________ Reservation upto _______________________________ Boarding at _______________________________________ Reservation upto _______________________________

S.No. Name in Block letter Sex(M/F) Age Concession/TravelAuthority No. Choice if any S.No. Name in Block letter Sex(M/F) Age Concession/TravelAuthority No. Choice if any
1. Lower/Upper berth 1. Lower/Upper berth

2. 2.

3. 3.

4. Veg./Non-veg. Meal 4. Veg./Non-veg. Meal

for Rajdhani/ for Rajdhani/ Shatabdi
5. Shatabdi Express 5. Express Only
Only
6. 6.

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

S.No. Name in Block Letters Sex Age S.No. Name in Block Letters Sex Age

ONWARD/RETURN JOURNEY DETAILS 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 __________
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 FOR OFFICE USE ONLY

S.No. of Requistion__________________________________________ PNR No.______________________________ S.No. of Requistion__________________________________________ PNR No.______________________________
Berth/Seat No.________________________________________ Amount collected _____________________________ Berth/Seat No.________________________________________ Amount collected _____________________________
___________________________ ___________________________
Signature of Reservation Clerk 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
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