........................

RAILWAY CM257
RESERVATION/CANCELLATION REQUISITION FORM

u are a Medical Practitioner Please tick ( ) in Box (You could be of help in an emergency) Dr.
u want Sr. Citizen concession, please write Yes/No in box (if yes, please carry a proof of
during the journey to avoinconvenience of penal charging under extant Railway Rules)

you want to be upgraded without any extra charge? Write Yes/No in

box. (If this option is not exercised, full fare paying passengers may be upgraded
matically)
n No & Name ___________________ Date of journey______________________
s ____________________________ No of Berth/Seat_______
on from _______________________ To __________________
ding at ______________________ Reservation upto _____________________

Name in Block letter(not more Concession/TravelAuthority

No. Sex(M/F) Age Choice if any
than 15 chars) No.

1. Lower/Upper
berth
Veg./Non-veg.
2.
Meal for
Rajdhani/
3. Shatabdi
Express Only
4.

5.

6.

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

S.No. Name in Block Letters Sex Age

ONWARD/RETURN JOURNEY DETAILS

ain No. & Name________________________ Date ________________________
ass ________ Station from:___________________ To________________________
ame of applicant _______________________________________________________
ll Address ___________________________________________________________
____________________________________________________________________
Signature of the Applicant/Representative
lephone No., if any _______________________ Date __________Time __________

FOR OFFICE USE ONLY

No. of Requistion_______________________ PNR No._______________________
erth/Seat No._______________ Amount collected _____________________________
_________________________
Signature of Reservation Clerk

: 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