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Booking/Cancellation Request Slip

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BOOKING/CANCELLATION REQUEST SLIP

Dated : S. No. : IRCTC/……………………….(Agent Code)

If you want Sr. Citizen Concession, please write Yes/No in box


(if yes, please carry a proof of age during the journey to avoid
inconvenience of penal charging under extant Railway RulesͿ

TICKET BOOKING REQUEST :

Train No. : Train Name : Date of Journey :

Class : From : To :

Boarding Point : Date of Booking : Quote : General

Tatkal
AMOUNT PAID TO AGENT :

PASSENGER DETAILS

S. No. Name Sex (M/F) Age Passenger to be


cancelled(To be filled at the
time of cancellation)
1    

2    

3    

4    

5    

6    


Customer Signature
-------------------------------------------------------------------------------------------------------------------------------

CANCELLATION REQUEST : Full Partial

PNR No. : Berth Seat No :

AMOUNT REFUNDED TO THE CUSTOMER :

*Children below 5 years (for whom ticket is not to be issued)

Customer Name :
Address & Contact No.   

Customer Signature

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