Form 2.

12 Application for the Special Identity Card issued to Ordinary Season

Ticket Holders and Zone Ticket Holders

01. Applicant’s Name with Initials :

……………………………………………………………………………..
02. Name denoted by the Initials :
……………………………………………………………………………...
03. Permanent Address:
……………………………………………………………………………..
……………………………………………………………………………..
04. National Identity Card Number and Date:
…………………………………………………………………………….
05. Railway Stations between which the applicant propose to travel using the
Season Ticket:
From: ………………………………….. To: ……………………………
06. Signature of the Applicant : ……………………………………………….
Date : ……………………………..
07. Certificate Regarding Applicant’s Identity: Photograph
I certify that this applicant is well known to me ( Size 2″ x 2 ¼″ )
and that he / she signed the application today in
my presence and that the particulars given in the
application are correct to the best of my
knowledge.
Signature of the Attester : ……………………………………………….
Name of the Attester : ………………………………………………..
Designation : ………………………………………………..
Place and Date : ……………………………. ………………
( Before filling this form, please consult the Station Master for clarifications )
For office use only
The special Identity Card - Issued / Not issued
Special Identity Card Number : ………………………………..
I acknowledge the receipt of the application of Mr. / Mrs. / Miss ..
….……………………………………. for a special identity card.
Signature of the Station Master : …………………………….. Date : ……….