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INDIAN RAILWAYS

RESERVATION / CANCELLATION / RETURN JOURNEY REQUISITION

Journey Details

Train No. & Name

Date of Journey

Class

No. of Berths/Seats

Station From

Station To

Boarding at Station

Reservation Upto

Mobile/Tel No.

Passenger Details (Max 6)

Sr.	Name in Block Letters (Max 15)	Nationality	Gender	Age	Concession/Auth No.	Choice of Berth	Meal
1
2
3
4
5
6

Children Below 5 Years

Sr.	Name	Nationality	Gender	Age
1
2

Onward/Return Journey Details

Train No. & Name

Date

Class

Station From

Station To

Applicant Details

Name of Applicant

Full Address

Aadhar No. (Optional)

Date

Time

Signature of Applicant

If you are a Medical Practitioner, please tick (✓) in Box (You could be of help in an emergency) If you are a Pregnant Woman and want to get Berth in Quota, please tick (✓) in the Box. If you want Sr. Citizen Concession, please tick (✓) in box. Do you want to be upgraded without any extra charge? Tick (✓) in box. If you want to get shifted to alternate train under 'VIKALP' scheme, please tick (✓). If you are travelling in 3AC Class of Garib Rath Express or Sleeper Class of Duronto Express, do you want bedroll in train? Tick (✓).

FOR OFFICIAL USE ONLY

Req. Sr. No.

PNR No.

Berth / Seat No.

Amount Collected

Sign. of Res. Clerk

INDIAN RAILWAYS

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