17-10-2012, 01:43 PM
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........................ 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
chars)
Sex(M/F) Age
Concession/TravelAuthority
No.
Choice
if any
1.
2.
3.
4.
5.
6.
Lower/Upper
berth
Veg./Nonveg. 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
