Application Under Section 16 Of The Railway Claims Tribunal Act 1987 Read With Rule 5 Of The Railway Claims Tribunal (Procedure) Rules 1989 In Respect Of Claims For Refund Of Fares Or Part Thereof Or For Refund Of Any Freight Paid In Respect Of Animals Or Goods Entrusted To A Railway Administration To Be Carried By Railway
Application Under Section 16 Of The Railway Claims Tribunal Act 1987 Read With Rule 5 Of The Railway Claims Tribunal (Procedure) Rules 1989 In Respect Of Claims For Refund Of Fares Or Part Thereof Or For Refund Of Any Freight Paid In Respect Of Animals Or Goods Entrusted To A Railway Administration To Be Carried By Railway Deed Format
In the Railway Claims Tribunal
Before the ……………. Bench
AB ………. ………… Claimant
And
General Manager ……….. Railways
……… Respondent
Index
Description of documents attached :
Signature of the applicant :
For use in Tribunal’s Office :
Date of Filing :
Registration No. :
Registrar : Signature
In the Railway Claims Tribunal
Before the …………….. Bench
between
AB …………… Claimant
And
General Manager ……………… Railways
Respondent
1. Particulars of the applicant:
Name: AB
Address:
2. Particulars of the respondent:
3. Value of the claim and details of application fee.
(a) value of claims: Rs. 5,00,000
(b) details of application fee:
4. Particulars of Bank Draft/Postal Order in respect of application fee:
(i) name and address of the Bank on which the draft is drawn. X Bank Ltd., Calcutta Branch.
(ii) demand draft No. ……………. payable at Calcutta Branch.

5. Full particulars of payment of freight/fare:
(a) Claim for refund of freight.
(i) date of booking
(ii) R/R/Parcel Way Bill
(iii) Station from …………….. to ……………..
(iv) description of consignment
(v) freight paid
(vi) amount of refund of claims
(vii) Money Receipt/Credit Note or other payment particulars.
(b) Claim for refund of fare:
(i) Date of journey
(ii) Train No.
(iii) Class of travel
(iv) Class actually travelled
(v) ticket or ticket deposit receipt/excess fare ticket etc. guard’s or conductor’s certificate
(vi) fare paid: Rs. ………………………
(vii) refund claimed: Rs. …………………
7. (i) Facts of the case.
(ii) (a) Nature of relief sought
(b) grounds of relief.
8. Matters not previously filed or pending with any other court (in case the applicant took any legal action give details and attach certified copy of the order).
9. Jurisdiction of the Bench.
10. List of enclosures.
Verification
Date: Signature of the applicant
Place: Full address:
To
The Registrar
Railway Claims Tribunal
……………. Bench
……………. Road
Calcutta
Application Under Section 16 Of The Railway Claims Tribunal Act 1987 Read With Rule 5 Of The Railway Claims Tribunal (Procedure) Rules 1989 In Respect Of Claims For Refund Of Fares Or Part Thereof Or For Refund Of Any Freight Paid In Respect Of Animals Or Goods Entrusted To A Railway Administration To Be Carried By Railway Deed Format
Email us at : [email protected]