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Annexure A - Standard Railway Pass Form

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ANNEXURE 'A' TO SCHEDULE II

[See Rule 6(1)]

STANDARD RAILWAY PASS FORM

 

Form No….

Standard Railway Pass Form 

 

With _____Kilogram luggage free for each adult and half that quantity for each child.

 

"The pass must be returned by the pass holder to the issuing office within a month of the date of expiry of the pass, with remarks used/cancelled.

Name of Break journey availed of

 

FREE PASS……………….CLASS

 

1. (a) Date of Arrival___

Designation ……………………………………..

    (b) Date of Departure __

Pass…………………………………………………….

 

From ……………………………………...To ……………………………………..

2. (a) Date of Arrival___

Via ………………………………………….and return via ……………………………………..

    (b) Date of Departure __

Over[1] ……………………….. Railway.

 

Available upto

Outward journey ………………………..

3. (a) Date of Arrival___

 

Return journey ………………………..

    (b) Date of Departure __

Signature/thumb impression of the holder. If the employee himself is not travelling The leading member of the family should sign or if illiterate put his/her thumb impression.

Outward journey

 

 

Return journey

4. (a) Date of Arrival___

To be signed at the

 

    (b) Date of Departure __

*Outward journey commenced on ……………………….. 19….

 

* Ret urn journey commenced on ……………………….. 19…

5. (a) Date of Arrival___

By any passenger train/mail train

 

    (b) Date of Departure __

Why granted ………………………..

 

 

 

 

………………………………………… 

Signature & designation

of the Issuing Officer with seal

 

 

*The date must be inserted in INK BEFORE commencement of journey in either direction . Ticket Collectors and T.T.Es. must see that this is complied with. They should also recover a fine of Rs.25/- on I-A/I class and Rs.10/- on II Class passes for not entering the date of commencement of journey on passes and endorsing the fact of recovery of fine on passes.  

 

References

1. Railway Board’s letter No. E(W) 2000 PS 5-1/11 dated 21.06.2004 (RBE No. 134/2004)

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