........................ 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)
  
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