More Related Content Similar to Railway res form Similar to Railway res form (20) 1. <!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN"
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<html xmlns="http://www.w3.org/1999/xhtml">
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<title>Reservation/Cancellation Requisition Form</title>
<link href="css/rail-style.css" rel="stylesheet" type="text/css" />
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<body>
<table width="100%" border="0" cellspacing="0" cellpadding="0">
<tr>
<td height="400" align="right" class="text_rail_left"></td>
<td width="900%" align="left" class="text_back_color"><table width="60%" align="center"
cellpadding="0" cellspacing="0" style="border-color:#000000;" border="1">
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<td><table width="96%" cellpadding="3" cellspacing="1" align="center" >
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<td><table width="100%" border="0" cellpadding="3" cellspacing="1">
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<td align="center"> </td>
<td align="center"> </td>
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2. <td width="50%" align="center">.......................... RAILWAY</td>
<td width="50%" align="center">CM257</td>
</tr>
<tr>
<td colspan="2" align="center" class="inside_heading_text"><br />
Reservation/Cancellation Requisition Form <br />
<hr width="100%"/></td>
</tr>
</table></td>
</tr>
<tr>
<td><table width="100%" border="0" cellpadding="3" cellspacing="1">
<tr>
<td colspan="2" align="left" class="main_body_text"> If you are a Medical Practitioner</td>
<td colspan="2" align="center" class="main_body_text"> </td>
</tr>
<tr>
<td colspan="2" align="left" class="main_body_text">Please tick ( ) in Box <br />(You could
be of help in an emergency)</td>
<td colspan="2" align="left" class="main_body_text"><input name="checkbox"
type="checkbox" />
Dr.</td>
</tr>
<tr>
<td colspan="2" align="left" class="main_body_text"> If you want Sr. Citizen Concession,
please write Yes/No in Box</td>
3. <td colspan="2" align="left" class="main_body_text"><select name="select7" style="width:
80px; font-size:10px;">
<option>Selection</option>
<option>Yes</option>
<option>No</option>
</select> </td>
</tr>
<tr>
<td colspan="4" align="left" class="main_body_text"> (if yes, please carry a proof of age
during the journey to avoid inconvenience of panel charging under extant Railway Rules)</td>
</tr>
<tr>
<td colspan="2" align="left" class="main_body_text"><strong>Do you want to be upgraded
without any extra charge? Write </strong></td>
<td colspan="2" align="left" class="main_body_text"><strong>
<select name="select" style="width: 80px; font-size:10px;">
<option>Selection</option>
<option>Yes</option>
<option>No</option>
</select>
</strong></td>
</tr>
<tr>
<td colspan="4" align="left" class="main_body_text"><strong>Yes/NO in the box. <br />
(if this option is not exercised, full fare paying passengers may be upgraded
automatically)</strong></td>
</tr>
4. <tr>
<td width="15%" align="left" class="main_body_text"> Train No & Name</td>
<td width="35%" align="left" class="main_body_text"><input name="text" type="text"
size="30"/></td>
<td width="15%" align="left" class="main_body_text">Date of journey</td>
<td width="35%" align="left" class="main_body_text"><input name="text" type="text"
size="10"/></td>
</tr>
<tr>
<td width="15%" align="left" class="main_body_text"> Class </td>
<td width="35%" align="left" class="main_body_text"><select name="select2" style="width:
50px; font-size:10px;">
<option>1A</option>
<option>2A</option>
<option selected="selected">3A</option>
<option>FC</option>
<option>CC</option>
<option>SL</option>
<option>2S</option>
</select></td>
<td width="15%" align="left" class="main_body_text">Number of Berth/Seat </td>
<td width="35%" align="left" class="main_body_text"><select name="select3" style="width:
50px; font-size:10px;">
<option>1</option>
<option>2</option>
<option>3</option>
5. <option>4</option>
<option>5</option>
<option>6</option>
</select></td>
</tr>
<tr>
<td width="15%" align="left" class="main_body_text"> Station From</td>
<td width="35%" align="left" class="main_body_text"><input name="text" type="text"
size="30"/></td>
<td width="15%" align="left" class="main_body_text">To</td>
<td width="35%" align="left" class="main_body_text"><input name="text" type="text"
size="30"/></td>
</tr>
<tr>
<td width="15%" align="left" class="main_body_text"> Boarding at </td>
<td width="35%" align="left" class="main_body_text"><input name="text" type="text"
size="30"/></td>
<td width="15%" align="left" class="main_body_text">Reservation upto</td>
<td width="35%" align="left" class="main_body_text"><input name="text2" type="text"
size="30"/></td>
</tr>
<tr>
<td align="left" class="main_body_text"> </td>
<td align="left" class="main_body_text"> </td>
<td align="left" class="main_body_text"> </td>
<td align="left" class="main_body_text"> </td>
</tr>
6. </table></td>
</tr>
<tr>
<td><table width="100%" cellpadding="3" cellspacing="1">
<tr style="color:#000000;background-color:#CCCCCC" class="main_body_text">
<td width="5%" align="center" bgcolor=""><strong>S.No.</strong></td>
<td width="23%" align="center"><strong>Name in Block Letters<br />
(not more than 15 letters)</strong></td>
<td width="7%" align="center"><strong>Sex(M/F)</strong></td>
<td width="7%" align="center"><strong>Age</strong></td>
<td width="23%" align="center"><strong>Concession/Travel Authority No.</strong></td>
<td width="17%" align="center"><strong>Choice <br />
(Lower/Upper Berth)</strong></td>
<td width="18%" align="center"><strong>Meals for Rajdhani/Shatabdi Express</strong></td>
</tr>
<tr class="main_body_text">
<td width="5%">1.</td>
<td width="23%"><input name="text3" type="text" size="35"/></td>
<td width="7%">
<select name="select4" style="width: 50px; font-size:10px;">
<option selected="selected">--</option>
<option>M</option>
<option>F</option>
</select>
</td>
7. <td width="7%">
<input name="text3" type="text" size="5"/>
</td>
<td width="23%"><input name="text4" type="text" size="35"/></td>
<td width="17%">
<select name="select21" style="width: 80px; font-size:10px;">
<option selected="selected">--</option>
<option>UB</option>
<option>LB</option>
</select>
</td>
<td width="18%"><strong>
<select name="select6" style="width: 90px; font-size:10px;">
<option>Selection</option>
<option>Veg.</option>
<option>Non Veg.</option>
</select>
</strong></td>
</tr>
<tr class="main_body_text">
<td width="5%">2.</td>
<td width="23%"><input name="text3" type="text" size="35"/></td>
<td width="7%">
<select name="select10" style="width: 50px; font-size:10px;">
<option selected="selected">--</option>
8. <option>M</option>
<option>F</option>
</select>
</td>
<td width="7%">
<input name="text3" type="text" size="5"/>
</td>
<td width="23%"><input name="text4" type="text" size="35"/></td>
<td width="17%">
<select name="select5" style="width: 80px; font-size:10px;">
<option selected="selected">--</option>
<option>UB</option>
<option>LB</option>
</select>
</td>
<td width="18%"><strong>
<select name="select6" style="width: 90px; font-size:10px;">
<option>Selection</option>
<option>Veg.</option>
<option>Non Veg.</option>
</select>
</strong></td>
</tr>
<tr>
<td width="5%">3.</td>
9. <td width="23%"><input name="text3" type="text" size="35"/></td>
<td width="7%">
<select name="select11" style="width: 50px; font-size:10px;">
<option selected="selected">--</option>
<option>M</option>
<option>F</option>
</select>
</td>
<td width="7%">
<input name="text3" type="text" size="5"/>
</td>
<td width="23%"><input name="text42" type="text" size="35"/></td>
<td width="17%">
<select name="select15" style="width: 80px; font-size:10px;">
<option selected="selected">--</option>
<option>UB</option>
<option>LB</option>
</select>
</td>
<td width="18%"><strong>
<select name="select6" style="width: 90px; font-size:10px;">
<option>Selection</option>
<option>Veg.</option>
<option>Non Veg.</option>
</select>
10. </strong></td>
</tr>
<tr>
<td width="5%">4.</td>
<td width="23%"><input name="text3" type="text" size="35"/></td>
<td width="7%">
<select name="select12" style="width: 50px; font-size:10px;">
<option selected="selected">--</option>
<option>M</option>
<option>F</option>
</select>
</td>
<td width="7%">
<input name="text3" type="text" size="5"/>
</td>
<td width="23%"><input name="text43" type="text" size="35"/></td>
<td width="17%">
<select name="select16" style="width: 80px; font-size:10px;">
<option selected="selected">--</option>
<option>UB</option>
<option>LB</option>
</select>
</td>
<td width="18%"><strong>
<select name="select6" style="width: 90px; font-size:10px;">
11. <option>Selection</option>
<option>Veg.</option>
<option>Non Veg.</option>
</select>
</strong></td>
</tr>
<tr>
<td width="5%">5.</td>
<td width="23%"><input name="text3" type="text" size="35"/></td>
<td width="7%">
<select name="select13" style="width: 50px; font-size:10px;">
<option selected="selected">--</option>
<option>M</option>
<option>F</option>
</select>
</td>
<td width="7%">
<input name="text3" type="text" size="5"/>
</td>
<td width="23%"><input name="text4" type="text" size="35"/></td>
<td width="17%">
<select name="select17" style="width: 80px; font-size:10px;">
<option selected="selected">--</option>
<option>UB</option>
<option>LB</option>
12. </select>
</td>
<td width="18%"><strong>
<select name="select6" style="width: 90px; font-size:10px;">
<option>Selection</option>
<option>Veg.</option>
<option>Non Veg.</option>
</select>
</strong></td>
</tr>
<tr>
<td width="5%">6.</td>
<td width="23%"><input name="text3" type="text" size="35"/></td>
<td width="7%">
<select name="select14" style="width: 50px; font-size:10px;">
<option selected="selected">--</option>
<option>M</option>
<option>F</option>
</select>
</td>
<td width="7%">
<input name="text3" type="text" size="5"/>
</td>
<td width="23%"><input name="text4" type="text" size="35"/></td>
<td width="17%">
13. <select name="select18" style="width: 80px; font-size:10px;">
<option selected="selected">--</option>
<option>UB</option>
<option>LB</option>
</select>
</td>
<td width="18%"><strong>
<select name="select6" style="width: 90px; font-size:10px;">
<option>Selection</option>
<option>Veg.</option>
<option>Non Veg.</option>
</select>
</strong></td>
</tr>
<tr>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
</table></td>
</tr>
14. <tr>
<td><table width="100%" border="0" cellpadding="3" cellspacing="1">
<tr class="main_body_text">
<td colspan="4" align="center" style="color:#000000; background-
color:#CCCCCC"><strong>CHILDREN BELOW 5 YEARS (FOR WHOM TICKET IS NOT TO BE
ISSUED)</strong></td>
</tr>
<tr class="main_body_text">
<td width="12%"><strong>S.No.</strong></td>
<td width="70%"><strong>Name in Block Letters (not more than 15 letters)</strong></td>
<td width="10%"><strong>Sex</strong></td>
<td width="8%"><strong>Age</strong></td>
</tr>
<tr class="main_body_text">
<td>1.</td>
<td><input name="text32" type="text" size="35"/> </td>
<td><select name="select8" style="width: 50px; font-size:10px;">
<option selected="selected">--</option>
<option>M</option>
<option>F</option>
</select> </td>
<td><input name="text34" type="text" size="5"/> </td>
</tr>
<tr class="main_body_text">
<td>2.</td>
<td><input name="text33" type="text" size="35"/> </td>
15. <td><select name="select9" style="width: 50px; font-size:10px;">
<option selected="selected">--</option>
<option>M</option>
<option>F</option>
</select> </td>
<td><input name="text35" type="text" size="5"/> </td>
</tr>
<tr>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
</table></td>
</tr>
<tr>
<td><table width="100%" border="0" cellpadding="3" cellspacing="1">
<tr class="main_body_text">
<td colspan="6" align="center" style="color:#000000;background-color:#CCCCCC"><strong>
ONWARD/RETURN JOURNEY DETAILS </strong></td>
</tr>
<tr>
<td width="13%" align="left" class="main_body_text"> Train No & Name</td>
<td width="20%" align="left" class="main_body_text"><input name="text5" type="text"
size="30"/></td>
<td width="14%" align="left" class="main_body_text">Date of journey</td>
16. <td width="14%" align="left" class="main_body_text"><input name="text5" type="text"
size="10"/></td>
<td width="5%" align="left" class="main_body_text">Class </td>
<td width="34%" align="left" class="main_body_text"><select name="select19"
style="width: 50px; font-size:10px;">
<option selected="selected">1A</option>
<option>2A</option>
<option>3A</option>
<option>FC</option>
<option>CC</option>
<option>SL</option>
<option>2S</option>
</select></td>
</tr>
<tr>
<td width="13%" align="left" class="main_body_text"> Station From</td>
<td colspan="2" align="left" class="main_body_text"><input name="text5" type="text"
size="30"/></td>
<td width="14%" align="left" class="main_body_text">To</td>
<td colspan="2" align="left" class="main_body_text"><input name="text5" type="text"
size="30"/></td>
</tr>
<tr>
<td width="13%" align="left" class="main_body_text"> Name of applicant </td>
<td colspan="2" align="left" class="main_body_text"><input name="text5" type="text"
size="30"/></td>
<td width="14%" align="left" class="main_body_text">Full Address</td>
17. <td colspan="2" align="left" class="main_body_text"><input name="text22" type="text"
size="50"/></td>
</tr>
<tr>
<td colspan="6"> </td>
</tr>
<tr class="main_body_text">
<td colspan="6"><strong>Signature of the Applicant/Representative
______________________</strong></td>
</tr>
<tr class="main_body_text">
<td width="13%" align="left" class="main_body_text"> Telephone No., if any</td>
<td width="20%" align="left" class="main_body_text"><input name="text5" type="text"
size="30"/></td>
<td width="14%" align="left" class="main_body_text">Date </td>
<td width="14%" align="left" class="main_body_text"><input name="text5" type="text"
size="10"/></td>
<td width="5%" align="left" class="main_body_text">Time </td>
<td width="34%" align="left" class="main_body_text"><input name="text342" type="text"
size="5"/>
:
<input name="text343" type="text" size="5"/>
:
<select name="select20" style="width: 50px; font-size:10px;">
<option>AM</option>
<option>PM</option>
</select></td>
18. </tr>
<tr>
<td align="left" class="main_body_text"> </td>
<td align="left" class="main_body_text"> </td>
<td align="left" class="main_body_text"> </td>
<td align="left" class="main_body_text"> </td>
<td align="left" class="main_body_text"> </td>
<td align="left" class="main_body_text"> </td>
</tr>
</table></td>
</tr>
<tr>
<td><table width="100%" border="0" cellpadding="3" cellspacing="1">
<tr class="main_body_text">
<td colspan="6" align="center" style="color:#000000; background-color:#CCCCCC"><strong>
FOR OFFICE USE ONLY </strong></td>
</tr>
<tr>
<td width="38%" align="left" class="main_body_text"> S.No. of
Requistion_______________________ </td>
<td width="62%" colspan="5" align="right" class="main_body_text">PNR
No._______________________</td>
</tr>
<tr>
<td width="38%" align="left" class="main_body_text"> Berth/Seat No._______________
</td>
19. <td width="62%" colspan="5" align="left" class="main_body_text">Amount collected
________________ </td>
</tr>
<tr>
<td align="left" class="main_body_text"> </td>
<td colspan="5" align="right"> </td>
</tr>
<tr>
<td width="38%" align="left" class="main_body_text"> </td>
<td width="62%" colspan="5" align="right"><strong>______________________ Signature of
Reservation Clerk</strong> </td>
</tr>
</table></td>
</tr>
<tr>
<td><table width="100%" border="0" cellpadding="3" cellspacing="1">
<tr>
<td width="8%" align="left" class="main_body_text" valign="top"> <strong>NOTE :</strong>
</td>
<td width="92%" align="left" class="main_body_text"> 1.Maximum permissible passengers is
6 per requisition.<br />
2. One person can giFve one requisition form at a time. <br />
3. Please check your ticket and balance amount before leaving the window.<br />
4. Forms not properly filled or in illegible forms shall not be entertained.<br />
5. Choice is subject to availability<br /></td>
</tr>
</table></td>
20. </tr>
</table></td>
</tr>
</table></td>
<td align="left" class="text_rail_right"></td>
</tr>
</table>
</body>
</html>
