Instruction for filling up the application form

1. Kindly fill up the claim application form complete in all respects and accompanied by relevant documents , original or photocopy. This will facilitate processing of your claim.
2. Methods for filling up the form are explained by the examples below:-
(a) Alphabets:
(b) Digits Rs.
(c ) Tickmarks : Railway Receipt:
: Parcel Way Bill
: FSLA
: Luggage Ticket
: Soldier Ticket
: Others
(d) Date
D D M M Y Y
(e) Wagon Particulars
Owning Rly :
Wagon No:
Type:
N E E R A J G U P T A
0 2 2 4 4 8 4 5
0 5 / 0 5 / 8 3
E R C
0 0 5 1 3 4 7
B O X