IRCTC Registration Form

Full Name: _ _

Shop Name: _ ___

Date of Birth (DD/MM/YYYY) _________________________________________________

Email id: _______________________________________________________

Mobile No: _ & Alternate No: _

Father name: _ __ _

Address: __ _

PAN card: _ _

Aadhar Card: _ _

IMEI No for android Phone ________________________________________________

IRCTC Charges SLAB

Monthly Transaction Monthly Charges*
Less Than 10,000 Rs 100 per Month
Rs 10,001- Rs 49,999 Rs 50 Per Month
Rs. 50,000 or above No Monthly Charges
Note: No AMC for first 30 days
*Above mentioned charges can be changed any time. 30 Days No ticketing agents will be
deactivated automatically
Note: agent have to follow all terms and condition mentioned on IRCTC agents portal & do and don’t

I hereby declare that all the statements

made by me in the application form are true and complete to the best of my knowledge

Date: _

Place: _ Signatures:
 Form I
[See rule 5(1)]
Application to be filled by agents for issue of licence through www.irctc.co.in.
[To be submitted in Hard Copy and Soft Copy]

* Mandatory
Individual/Firm/Company Name *

Person Representing Firm/Company

First Name *

Middle Name

Last Name *

Date Of Birth *

Office Address *

City *

State *

Pincode *

Country*

Phone Number*

Mobile Number

Contact No

Fax No

Email Id *

Customer care No.

Customer care email

Pan Card*

Date:
Place:
Signature of the Applicant