STANDARD RAILWAY PASS FORM (ANNEXURE 'A' TO SCHEDULE II)

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 ________________ 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