You are on page 1of 1

IRCTC Registration Form

RO Number:
Company Name:
Owner Name: (First Name - Middle Name Last Name)
Contact No.: (First number of customer should be a Mobile Number)
Contact Number: (Residence Number)
E Mail Id.:
Address1 : (Where RO is taking the agency)
Address 2: (Where RO is taking the agency)
City:
State:
PinCode:
PAN Card No.:
RMU Number: (Under whom he need to mapped)
RMU Name: (Under whom he need to mapped)
Note: The above information should be complete. RO also need submit following document in
electronic format to process his request for IRCTC registration.
1. Copy registration form
2. Photo (Recent Photograph)
3. Address Proof (For the same where he is taking the agency)
4. PAN Card copy
I hereby declare that above mentioned information is correct as per my knowledge and I shall take a
full responsibility if this is found in correct.
Date:
Place:
Signature
___________________
(Full Name)