Application Form YP08CW

Please complete the appropriate sections and boxes electronically or print off and write CLEARLY and in BLOCK CAPITALS.
If you are living away from home, please provide both your home and term time address.
Title
Mr Mrs Miss Ms Other Please specify Date of Birth D D MM Y Y Y Y
(please select as appropriate)

First Name Surname

Home Address

Town Postcode
INC
CODE
Telephone Mobile Phone
By providing your mobile number you opt in for SMS communications

Term Address

Town Postcode
INC
CODE
Telephone
Can we have your email address? Email is the most environmentally-friendly way for you to hear about Railcard news and any of our great offers. To opt in for emails, simply
enter your email address here

Occupation School/FE student Part-time student HE/University student Mature student

(please select as appropriate)
Full-time employed Part-time employed Not in employment

Renewals Are you renewing your

16-25 Railcard? Yes No If so, what is your existing Railcard Number?
Expiry date of
existing Railcard D D MM Y Y Y Y How many 16-25 Railcards have you held in the past?

Mature Students Only

Students aged 26 years and over, in full-time education must also complete this section if they do not have an ISIC card to use as proof of eligibility. Your tutor, head tutor or head of department needs to complete
and sign below: I confirm that the applicant is a student attending University/College for over 15 hours per week, at least 20 weeks a year. I have signed and stamped the photo on the back.
University/College Stamp: Signature

Date D D MM Y Y Y Y Position
Name of University/College

Declaration
Before signing this declaration, it is important that you have read, understood and agree to the Terms and Conditions of the Railcard, together with the National Rail Conditions of Carriage. Copies of the National Rail
Conditions of Carriage are available from any staffed station ticket office or online at www.nationalrail.co.uk. I have read, understood and agree to the Terms and Conditions of the Railcard. I confirm that the details I
have provided are correct and I am aged between 16 and 25 years or a mature student.
Signature

Date D D MM Y Y Y Y
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. If you do NOT wish to receive such information 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
Third party offers of goods and services

FOR ISSUING OFFICE USE ONLY Station or Travel Agent Stamp:

New Railcard No.

Photocard No.
Date of Application D D MM Y Y Y Y Please remember to also complete the ‘Receipt’ section on this leaflet.

Card Expiry Date D D MM Y Y Y Y Station/Agency NLC or Code No.

Please ensure that the issuing station/National Rail licensed Travel Agent fills in this section for you.

16-25 Railcard Receipt

This form acts as your receipt of purchase for your 16-25 Railcard, and must be shown should you need to get a replacement Railcard. It’s best to keep this separate from your Railcard.

Station or Travel Agent Stamp:

Railcard Holder’s Name

Railcard No:

Expiry Date: D D M M Y Y Y Y

APPROVED BY INITIALS SIGNATURE

Job No: 4690 Revision
Date: 28/08/08 Production
Filename:
Finished Size:
4690 ATOC 16-25 Website Form YP08CW
297mm x 210mm
5 Art Director

4 COLOUR PROCESS Copywriter

PMS 2765 Client Service

Client