ࡱ> ;=:[ 5bjbj ..ΐΐ5WWWWWkkkk<k. "BW|WWvvvWWvvv:,V@k ~0R##V#WV(v<:# : 9 Application Format I)Proforma for requisitioning a Special Coach/Train CENTRAL RAILWAY General Manager (Operations), Date: / / Central Railway, HQ Office, CST, Mumbai-400 001. 1.Name (In block letter) :__________________________ 2.Full Postal Address :__________________________ __________________________ __________________________ 3.Tele.No.and Mobile :__________________________ 4. Purpose of Journey :__________________________ Type and No. of Coaches required :__________________________ 6. Amount deposited 7.Details of Money Receipt(No. & Xerox) :__________________________ 8.Station where money deposited :__________________________ 9. Itinerary: (I) Outward Journey a)Station :__________________________ b)Date :__________________________ c)From/To :__________________________ d)Train Particulars :Name_____________No._____ (II)Return Journey) a)Station :__________________________ b)Date :__________________________ c)From/To :__________________________ d)Train Particulars :Name_____________No._____ 10 Halts required Enroute :__________________________ 11 Duration of Halt :__________________________ 12 Requirement of Special Free Halts for Entraining and Detraining :__________________________ 13 Sponsorship Details (eg. Tour Operator) :__________________________ 14Detailed Programme (Including return journey to be attached) :____________________________ DECLARATION: (1) I certify that the contents of this application are true to the best of my knowledge. (2) My application is liable to be rejected in case it is found to be fictitious or in anybody else's name. (3)I certify that the Coach/Coaches allotted to me will be returned to the Railway in sound condition and Deficiency Certificate obtained from SS/SMs concerned shall be enclosed while applying for refund. (4)I agree to pay Detention Charges as due in case the Coach/Coaches/Tourist Car are detained enroute or at destination on my account. (5) I certify that I shall not carry any inflammable or hazardous material in the Coach/Coaches during the course of my journey. (6) I agree to indemnify the Railways against any damage, whatsoever, caused to railway assets during the course of the tour. Signature of the applicant. Name & Address:_________ ________________________ ________________________ Encl:One Identify Proforma along with the necessary documents. (II) Proforma establishing Identity of the Applicant CENTRAL RAILWAY  1. Name: ___________________________________ 2. Fathers Name:____________________________ 3. Postal Address:____________________________ ____________________________ ____________________________ 4. Permanent Address:________________________ ____________________________ ____________________________ 5. Phone No. :Office__________(Residence)_______________ 6. Income Tax PAN No.:_______________ 7. Copy of Ration Card Or Telephone Bill Or Electricity Bill authenticating the address of Manager of the tour. 8. I am liable to pay undercharges if any and also compensate for damages if any to Railway Property as demanded by Railway Administration. Signature: ________________ Name:____________________ Address:__________________ To be Witnessed by Two Persons: Witness No.1: Witness No. 2 Signature:________________ Signature :________________ Name & Address:_ _________ Name & Address:__________ _________________________ ________________________ _________________________ ________________________ Phone No.:________________ Phone No.:_______________ CHECK LIST FOR REQUISITIONING FOR A SPECIAL COACH/TRAIN HAVE YOU SPECIFIED Train Particulars(Name and Number) Date of Commencement of Journey From/To Route Halts Required Enroute/Duration of Halt Entraining/Detraining Halts Required Detailed Programme from end to end Income Tax PAN Card Number Sponsorship Details HAVE YOU ENCLOSED a) Photocopy of Money Receipt. b) A Pasted Photo Graph. c) Copy of Ration Card/ Telephone Bill/Electricity Bill. d) Photocopy of I.T. 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