Fillable Printable Senior Railcard Application Form
Fillable Printable Senior Railcard Application Form
Senior Railcard Application Form
IMPORTANT. Please complete the appropriate sections and boxes CLEARLY and in BLOCK CAPITALS.
SN15A
Save £3 - apply online at senior-railcard.co.uk/leaflet
APPLICATION FORM
RENEWALS
Please continue overleaf
Are you renewing your existing Railcard?
D D
M
M
Y
Y Y
Y
Expiry date of
existing Railcard
NoYes
How many Railcards have you held in the past?
*Must be completed
First Name*
Surname*
Address*
Town*
Telephone
inc. code
Postcode*
Occupation Full-time employed Part-time employed Not in employment Retired
Title*
D D M M Y Y
Y
Y
Mr Mrs Miss Ms Other Date of Birth
M
F
Gender
Mobile
Phone
Email is the most environmentally-friendly way for you to hear about Railcard news, renewals and all of our great offers.
Email address
(Please tick as appropriate)
Before signing this declaration, it is important that you have read, understood and agree to the conditions shown in this leaflet.
I have read, understood and agree to the conditions shown in this leaflet. I confirm that the details I have provided are correct and I am aged 60 years or over.
*Must be completed
Date
D D
M
M
Y
Y Y Y
FOR ISSUING OFFICE USE ONLY
Please return this form promptly. Refer to the online manual for details.
STATION OR TRAVEL AGENT STAMP:
SN15A
On behalf of the Train Companies, ATOC Ltd collects and processes personal information for the purpose of sales analysis and market research.
ATOC Ltd is registered in the UK under the Data Protection Act 1998 as Data Controller. We will contact you when your card is close to expiry.*
From time to time your personal details may be used to send you relevant information as described below.
*Provided we hold valid contact details.
If you do NOT wish to be contacted for other marketing purposes please tick the relevant boxes.
I do NOT want to receive by Mail by Email by SMS
Railcard information and offers
Train Company offers and other rail-related services
We would also like to share your information with third parties so that they may send you information about their products and services.
If you do NOT want to receive this information by post, please tick here
If you do want to receive this information by email or SMS, please tick here
Station/Agency NLC or Code No:
D D M
M
Y Y
Y
Y
Card Expiry Date:
D
D M
M
Y
Y Y
Y
Date of Application:
New Railcard No:
Signature*
DECLARATION
