........................ RAILWAY CM257 RESERVATION/CANCELLATION REQUISITION FORM If you are a Medical Practitioner Please tick ( ) in Box Dr. [ ] (You could be of help in an emergency) Train No & Name ___________________ Date of journey______________________ Class ____________________________ No of Berth/Seat_______ Station from _______________________ To __________________ Boarding at ______________________ Reservation upto _____________________ S.No. Name in Block letter(not more than 15) Sex(M/F) Age Concession/TravelAuthority No. Choice if any Lower/Upper berth Veg./Non veg. Meal for Rajdhani/ Shatabdi Express Only CHILDREN BELOW 5 YEARS (FOR WHOM TICKET IS NOT TO BE ISSUED) S.No. Name in Block Letters Sex Age ONWARD/RETURN JOURNEY DETAILS Train No. & Name________________________ Date ________________________ Class ________ Station from:___________________ To________________________ Name of applicant _______________________________________________________ Full Address ___________________________________________________________ ______________________________________________________________________ ____________________________________________________________________ Signature of the Applicant/Representative Telephone No., if any _______________________ Date __________Time __________ FOR OFFICE USE ONLY S.No. of Requistion_______________________ PNR No._______________________ Berth/Seat No._______________ Amount collected _____________________________ _________________________ Signature of Reservation Clerk Note : 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
