........................ 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) AgeConcession/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
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