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Railway Form

Railway Form

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Published by: birjubrijesh on Aug 28, 2010
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05/13/2011

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RAILWAY CM257
RESERVATION/CANCELLATION REQUISITION FORM
If you are a Medical Practitioner Please tick ( ) in o! (You could "e of #el$ in an e%er&ency)
'r.
If you (ant )r. Citi*en concession+ $lease (rite Yes,-o in "o! (if yes+ $lease carry a $roof of
a&e durin& t#e .ourney to a/oid incon/enience of $enal c#ar&in& under e!tant Rail(ay Rules)
Do you want to be upgrae w!t"out any e#tra $"arge% &r!te 'e(/No !n
t"e bo#. )I* t"!( opt!on !( not e#er$!(e+ *u,, *are pay!ng pa((enger( -ay be upgrae
auto-at!$a,,y.
0rain -o 1 -a%e 2222222222222222222 'ate of .ourney2222222222222222222222
Class 2222222222222222222222222222 -o of ert#,)eat2222222
)tation fro% 22222222222222222222222 0o 222222222222222222
oardin& at 2222222222222222222222 Reser/ation u$to 222222222222222222222
S.No.
Na-e !n /,o$0 ,etter)not -ore
t"an 12 $"ar(.
Se#)M/F. Age
Con$e((!on/Tra3e,Aut"or!ty
No.
C"o!$e !* any
3.

Lo(er,4$$er
"ert#
5e&.,-on6/e&.
Meal for
Ra.d#ani,
)#ata"di 7!$ress
8nly
2.

9.

:.

5.

;.

C<IL'R7- 7L8W 5 Y7AR) (=8R W<8M 0IC>70 I) -80 08 7 I))47')
S.No. Na-e !n /,o$0 Letter( Se# Age


ON&ARD/RETURN 4OURNE' DETAILS
0rain -o. 1 -a%e222222222222222222222222 'ate 222222222222222222222222
Class 22222222 )tation fro%?2222222222222222222 0o222222222222222222222222
-a%e of a$$licant 2222222222222222222222222222222222222222222222222222222
=ull Address 22222222222222222222222222222222222222222222222222222222222
2222222222222222222222222222222222222222222222222222222222222222222222
S!gnature o* t"e App,!$ant/Repre(entat!3e
0ele$#one -o.+ if any 22222222222222222222222 'ate 22222222220i%e 2222222222
FOR OFFICE USE ONL'
).-o. of Re@uistion22222222222222222222222 P-R -o.22222222222222222222222
ert#,)eat -o.222222222222222 A%ount collected 22222222222222222222222222222
2222222222222222222222222
)i&nature of Reser/ation Clerk
-ote ? 3.Ma!i%u% $er%issi"le $assen&ers is ; $er re@uisition.
2. 8ne $erson can &i/e one re@uisition for% at a ti%e.
9. Please c#eck your ticket and "alance a%ount "efore lea/in& t#e (indo(.
:. =or%s not $ro$erly filled or in ille&i"le for%s s#all not "e entertained.
5. C#oice is su".ect to a/aila"ility

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