ATOC logo/RSTL name

							                                                                                                                           RSTL25805

                                                  RAIL STAFF TRAVEL LIMITED
                                    APPLICATION FOR REFUND OF STAFF TICKETS
EMPLOYEE DETAILS
Title Mr Ms                 Mrs      Miss        NI No                                  Date of birth
First name                                                    Last name
Home address
                                                                                        Post code
Tel No (mobile)                                                     Email
EMPLOYMENT DETAILS
Employer                                                      Employed as
Date ent’d service                                            Grade
Status                            Active    Retired           Class of travel           Std      1st
FROM (STN)                TO(STN)            SINGLE/     CLASS OF     DATE OF    STN WHERE     TICKET NO.      £      P
                                             RETURN      TRAVEL
                                                                      PURCHASE   PURCHASED
(A) DETAILS OF TICKETS PURCHASED FOR WHICH REFUND IS CLAIMED (SEND IN ACTUAL TICKETS WITH FORM)




                                                                                               TOTAL
(B) DETAILS OF ORIGINAL TICKETS WHICH WOULD HAVE COVERED JOURNEYS ABOVE*




PAYMENT METHOD USED                   Cash/Cheque/Credit/Debit card CARD TYPE:
Refund will be made at the ticket office by the same method
*REASON IN FULL FOR CLAIM (must be completed in all cases)



I hereby apply for a refund as indicated above, subject to the Conditions of Issue and Use which can be
found at www.atoc.org/rst (or from my normal travel facilities contact point).
Signed by employee
Date
Authorised by employer
Date
Once completed (save electronically as “RSTL25805_lastname_NInumber”) submit via your normal travel facilities contact point.
FOR RSTL USE:                                                 FOR TICKET OFFICE USE:
Name                               Date                       Clerk’s initials               Date
Sum due £                      Pay at Stn name                Stn name                       Sum paid           £
Authorisation stamp                                           Authorisation stamp



Received by claimant
Date

                             RAIL STAFF TRAVEL LIMITED (www.atoc.org/rst) is part of:


Issue date 1 March 2011