New Free Ticket Request

Safeguarded Staff only

* - Mandatory Field

Employee Details

Title*

First Name*

Last Name*

NI Number*

Date of Birth*

Address 1*

Address 2

Town*

County

Postcode*

Home Phone

Mobile No

Email*

Free Ticket Details*

Category of Application:

Other (Specify)

Person Travelling

Dependant Names (Specify)

Outward Travel Date

Return Travel Date

From:

To:

Application Reason

Attached Document

Notes On Completion of this Form
Applications must be supported by additional details and/or proof attached to this application to establish eligibility. This includes, but is not limited to: For First Aid - confirmation of certification dates (including copies of certificates if not already provided) For Hospital Visits - confirmation of appointment or treatment in addition to the relationship to the patient For Funerals - confirmation of funeral details in addition to the relationship to the deceased For Educational Visits - details of meeting/convention/visit and evidence of current membership of the organisation, e.g. Permanent Way Institution Locomotive and Carriage Institution of Great Britain and Eire RST may require further supporting documentation to establish eligibility.

Notes On Completion of this Form

Applications must be supported by additional details and/or proof attached to this application to establish eligibility. This includes, but is not limited to:

For First Aid - confirmation of certification dates (including copies of certificates if not already provided)
For Hospital Visits - confirmation of appointment or treatment in addition to the relationship to the patient
For Funerals - confirmation of funeral details in addition to the relationship to the deceased
For Educational Visits - details of meeting/convention/visit and evidence of current membership of the organisation, e.g.

Permanent Way Institution
Locomotive and Carriage Institution of Great Britain and Eire

RST may require further supporting documentation to establish eligibility.

Declaration*

By checking this box:By submitting this form:

I confirm that all details provided are correct.
I apply for the Free Tickets requested for myself and my eligible dependants (as indicated) and confirm that I am not receiving any travel expenses for this requested journey.
I understand that I am responsible for the correct use of my (and any dependant's) rail staff travel facilities and understand that such use is subject to the Conditions of Issue and Use which can be found at www.raildeliverygroup.com/rst/conditions-of-issue-and-use.
I further understand that Rail Staff Travel’s privacy information is available online at www.raildeliverygroup.com/rst/rst-privacy and that I have read it and have made my dependant(s) aware of it.
If I am in any doubt about eligibility, I understand that I MUST check and that any attempt to obtain or use rail staff travel facilities fraudulently may result in disciplinary action and/or legal proceedings and/or permanent withdrawal of all rail staff travel facilities for myself and all of my dependants.

Signed by Employee:

Date:

Form - Free Tickets - XX14 - This form is not valid for use after 31/03/2021

Once completed save the form with a filename of “YourLastname_YourFirstname_XX14_ddmmyyyy” – where ddmmyyyy is the date that you send the form to RST). Then submit via email to rst@raildeliverygroup.com or your normal rail staff travel facilities contact point