Indian Railway Catering & Tourism Co - Operation Limited: (Registration Form)

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IRCTC Form

Indian Railway Catering & Tourism Co - Operation Limited


(Govt. of India Undertaking)

(REGISTRATION FORM)
To be lled by Multilink Distributors requesting for Online Booking through
www.irctc.co.in
[To be submitted in Hard Copy & Soft Copy]

* MANDATORY

Company Name*
Person Representing Company
First Name*
Middle Name *
Last Name *
Date of Birth*
Ofce Address *
City *
State*
Pincode*
Country *

India

Phone Number *
Fax Number *
Email Id *
Contract Begin Date*
Contract End Date*
Demand Draft No.*
Date of issue *
Drawn on the Bank *
Multilink Distributors User Name As
in his Digital Certicate
Certication Authority Name*
Digital Certicate Serial Number *
Name* _______________________
Date* _______________________

Digital Signature
Registration Form for Digital Signature Certicate [Idividuals]
Customer Identication Number: ________________
Instructions:

Afx recent
passport size
photograph of
the Applicant

1. Please ll the form in BLOCK LETTERS in English only.


1. TYPE OF DIGITAL CERTIFICATE
3. ClassIlla
2. CERTIFICATE VALIDITY

(Required only for Class


llla & lllc Applicant)

2 Yrs.

3. NAME OF THE APPLICANT (As required in the DIGITAL CERTIFICATE)


(Please ensure that the name as it appear in the Identity Proof matches with the name mentioned below)

4. RESIDENTIAL ADDRESS

Town/City/District
State/Union Territory
Pin
Telephone No.
(STD COde)

Fax No
Mobile Phone No.

5. DATE OF BIRTH
(eg.20

0)

6. E-MAIL ADDRESS

7. IDENTITY DETAILS
(Please tick and
Licensed Certifying Authority

Applicant Signature

Executive Name

Distributor Name

Refered by

Branch Name

Director Signature

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