Application for HM Forces Railcard

Annex E to

2012DIN01-227

Dated Nov 12

APPLICATION FOR HM FORCES RAILCARD (………………….) (YEAR)

RANK/
RATE / SURNAME / FORENAMES / SERVICE NUMBER / WHERE SERVING / SERIAL NUMBER OF RAILCARD/
PHOTOCARD / WITHDRAWN/
LOST/
DESTROYED / DATE ACTIONED

DETAILS OF ELIGIBLE FAMILY MEMBERS

RELATIONSHIP / DATE OF BIRTH / SURNAME / FORENAMES / SERIAL NUMBER OF RAILCARD/
PHOTOCARD / WITHDRAWN/
LOST/
DESTROYED / DATE ACTIONED

I hereby apply for a HM Forces Railcard for *myself and the eligible members of my family. I understand that a charge as outlined in the current DIN will be made for each Railcard issued and that this amount will be deducted through the next available payroll. I accept that this Railcard is issued by MOD on behalf of ATOC. The purpose for which the Railcard may be used and the conditions booklet accompanying it are the responsibility of ATOC. MOD is not to be regarded for the purposes of the Railcard as an agent of ATOC. No liability for any losses, damages, inconvenience, delay or any other problems experienced as a result of the use of the Railcard or any services available under the Railcard is to be inferred or imputed, directly or indirectly on or to the MOD. Any complaints, claims or requests relating to the use of the Railcard and any losses, damages, inconveniences, delay or any other problem experienced as a result of the use of the Railcard or any services under the Railcard must be addresses to ATOC.

I am aware that any misuse of this Railcard could lead to disciplinary action being instigated. The attached full-face passport type photograph(s) (see note) for each person listed above has been endorsed with their full names on the reverse.

I hereby certify that those for whom I am applying for a HM Forces Railcard are eligible under the rules outlined in the current Defence Instruction Notice (DIN). I understand that I will be required to surrender the Railcard issued to myself* and/or any member of my family at any time the conditions of issue (as printed on the reverse side of the accompanying booklet) are contravened or the holder ceases to be eligible to hold a HM Forces Railcard due to age, change in Marital Status/PStat Cat or for any other reason. I accept that no refund will be made on the surrender of any Railcard belonging to me or to members of my family.

Signature……………………………………… Date………………………………………….

Revised 11/12E – 1

*delete appropriate item. Note: Photographs should not exceed 41 mm x 50mm