Fillable Printable Student Application Form for Railcard
Fillable Printable Student Application Form for Railcard
Student Application Form for Railcard
ApplicationForm
IMPORTANT. Please complete the appropriate sections and boxes CLEARLY andinBLOCK CAPITALS.
Occupation Full-time employment Part-time employment
Retired Notinemployment
Renewals Are you renewing your If so, whatisyour existing
existing Network Railcard?
Yes No
Network Railcard Number?
Expiry date of How many Network Railcards
existing Railcard have you heldinthe past?
Please enter your email address.
Emailisthe mostenvironmentally-friendly way for youtohear about Railcardnewsand anyofour greatoffers.
EmailAddress
Title
Mr Mrs Miss
Ms
Other
Date of Birth
(please tick as appropriate)
First Name*
Surname*
H
ome Address*
Town*
Postcode*
T
el
inc. code
Mobile Phone
D
D M M Y Y Y Y
D D M M Y Y
Y
Y
NR14W
Declaration
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.
*Must be completed
Date
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 a Data Controller.
From time to time your personal details may be used to send you relevant information as described below:
IdoNOTwanttoreceive:
I DO wanttoreceive:
by Mail by Email by SMS
Railcard information andoffers
Train Companyoffers and other rail-related services
Third party offersofgoods and services
FORISSUINGOFFICEUSE ONLY
New Railcard No.
Date of Application
Card Expiry Date
Station/Agency NLC
or Code No.
Signature*
D
D
M M Y
Y Y
Y
D D
M
M Y Y Y Y
D D M
M
Y
Y Y
Y
Station Stamp:
Please remember to also complete the ‘Receipt’ section on this leaflet.
Conditions of issue and use of the Network Railcard and reduced priced tickets (‘discounted tickets’) bought
with a Network Railcard.
ATOC Limited enters into the contract for the issue and use of the Network Railcard on behalf of the Train Companies. Reference to a 'Train Company',
or the 'Train Companies' means those Train Companies which, pursuant to a franchise agreement, operate Passenger Rail Services within the area
identified on the map in this leaflet.
1. You must sign the Railcard before use to show acceptance of all the conditions listed in this leaflet. The Railcard and tickets bought with it are not
transferable and must not be given, loaned or resold to anyone else. Only the named cardholder can use the Railcard.
2. You must be aged 16 years or over to purchase a Network Railcard.
3. Tickets for your journey should be purchased before boarding the train and when buying tickets you must show the Railcard.
4. You must carry your Railcard with you on your journey and when asked by rail staff, you must show a valid ticket and valid Railcard. If you fail to
do so, you and, where applicable, each member of your group will be required to pay the full price Standard Single fare for your journey as if no
ticket was purchased before starting your journey and in some cases a Penalty Fare. This does not apply if there was no ticket office at the station
at which you began your journey or if the ticket office was closed and there was no ticket machine from which you could buy a discounted ticket.
5. You will be asked to pay the difference between the price of your discounted ticket and the full price Standard fare (or the Penalty Fare if travelling in
the Penalty Fares area) if:
a) you travel beyond the station for which your ticket is issued;
b) you travel to a destination beyond the area shown on the map in this leaflet, without having first obtained the correct ticket for your journey;
c) you travel on a route for which a higher fare applies or at a time when reduced fares do not apply.
6. Network Railcard discounts only apply for travel after 10.00hrs Monday to Friday (excluding public holidays) and any time on weekends.
7. A £13 minimum fare applies to all journeys Monday to Friday, excluding public holidays. A £1 minimum fare applies to child fares at all times.
Travelcard minimum fares also apply – see www.network-railcard.co.uk for details. Please note, minimum fares are subject to change during the
validity of your Railcard.
8. The maximum group size is up to four adults (aged 16 years and over) including the named cardholder, and four children (aged 5 - 15 years).
9. Additional accompanying passengers for whom discounted tickets are purchased must travel with the Railcard holder throughout the journey.
10. Discounted tickets entitle you to travel only in Standard accommodation on the services of the participating Train Companies.
11. The Railcard and all tickets issued at a Railcard discount are issued subject to the National Rail Conditions of Carriage and the conditions listed in
this leaflet (and, where appropriate, to the Conditions of Carriage of Transport for London, Red Funnel Ferries and Wightlink). Copies of the National
Rail Conditions of Carriage are available online at www.nationalrail.co.uk/nrcc.
12. The Railcard will not be valid if it is damaged. The Train Companies do not undertake to replace damaged, lost or stolen Railcards, or to issue
refunds on unused/unwanted Railcards, or to extend their validity. However, an application for the replacement of a Railcard may be made at a
staffed station ticket office in the Network Railcard area (the completed 'Receipt' voucher of the original application form must be produced). A £10
administration fee will be payable for the replacement of a damaged or lost Railcard. No fee will be charged for the replacement of a stolen Railcard
upon presentation of a crime reference number/documentation issued by the Police. You will be requested to show some form of identification if
obtaining a replacement from a station.
13. The Railcard does not become your property and if requested must be handed in to a representative of any Train Company.
14. The right is reserved to revise these Conditions and availability of the tickets detailed in the Network Railcard leaflet. The Train Companies will
endeavour to give three months' notice of any changes before they are due to come into effect.
Fraudulent use of Railcards and Railcard discounted tickets may lead to a criminal prosecution.
This leaflet is valid up to and including 01 January 2015. NR14W
Network Railcard Receipt
This section to be completed by the issuing station and handed to the customer with the
issued Network Railcard.
Railcard Holders Name:
Railcard Number: Card Expiry Date:
Station Stamp:
This form acts as a receipt of purchase for your Network Railcard, and must be handed in should you
need to request a replacement. It’s best to keep this separate from your Railcard.
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