Diary No.

- Date :-

NORTH EASTERN RAILWAY,VARANASI

APPLICATION FOR EMERGENCY QUOTA
(RECOMMENDED BY RAILWAY OFFICIALS)

TO,
Sr. D.C.M.
N.E. Railway
VARANASI

S.NO. PARTICULAR OF PASSENGER

1 TRAIN NO.
2 DATE OF JOURNEY
3 CLASS
4 FROM – TO (STATION)
5 PNR NO.
6 NAME OF PASSENGER
7 RELATION
8 MOBILE NO OF PASSENGER
9 PURPOSE
10 ADDRESS OF PASENGER

11 APPLICANT’S SIGNATURE,
NAME,
DESIGNATION & MOBILE NO.
OR
REFRENCE ( IF ANY )

I certify that I am fully aware of the entitltment regarding allotment of berth through E.Q. and I certify that
the passenger is eligible and attest the identity of the passenger(s). I hereby undertake full responsibility of
passenger(s) credentials for whom I am recommending for allotment of berth(s) from E.Q.
S.NO. PARTICULARS OF RECOMMENDING RAILWAY OFFICIAL
1 NAME
2 DESIGNATION
3 OFFICE
4 MOBILE NO.

SIGNATURE OF
RECOMMENDING
RAILWAY OFFICIAL