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Railway Form.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<title>Railway reservation Form</title>
<link rel="stylesheet" href="style.css">
</head>
<body>
<form action="" method="get">
<div class="sl-fix">
<div class="col">
<div class="tc">
<div class="ac">....................... RAILWAY</div>
<div class="tr" style="padding-right:2rem">CM257</div>
<div class="mt-1">RESERVATION/CANCELLATION REQUISITION FORM</div>
</div>
</div>
<div align="tc">
<table class="t1 tp">
<tbody>
<tr>
<td>If you are a Medical Practitioner Please tick ( ) in Box
(You could be of help in an emergency)
</td>
<td width="66" >Dr. <input type="checkbox" name="dr"> </td>
</tr>
<tr>
<td>If you want Sr. Citizen concession, please write Yes/No in box (if yes, please carry a proof of
age during the journey to avoid inconvenience of penal charging under extant Railway Rules)
</td>
<td width="66" >
<select>
<option value="yes">Yes</option>
<option value="no">No</option>
</select>
</td>
</tr>
<tr>
<td>
<div><b>Do you want to be upgraded without any extra charge? Write Yes/No in the box.</b></div> (If this option is not exercised, full fare paying passengers may be upgraded automatically)
</td>
<td width="66" >
<select>
<option value="yes">Yes</option>
<option value="no">No</option>
</select>
</td>
</tr>
<tr>
</tbody>
</table>
</div>
<div class="col">
<div class="ha">
<div class="fe">
<label for="">Train No & Name</label>
<input type="text">
</div>
<div class="fe">
<label for="">Class</label>
<input type="text">
</div>
<div class="fe">
<label for="">Station from</label>
<input type="text">
</div>
<div class="fe">
<label for="">Boarding at</label>
<input type="text">
</div>
</div>
<div class="ha">
<div class="fe">
<label for="">Date of journey</label>
<input type="date">
</div>
<div class="fe">
<label for="">No of Berth/Seat</label>
<input type="number" max="6">
</div>
<div class="fe">
<label for="">Station To</label>
<input type="text">
</div>
<div class="fe">
<label for="">Reservation upto</label>
<input type="text">
</div>
</div>
</div>
<div class="mt-1">
<table class="t1">
<tbody>
<tr>
<th>S.No.</th>
<th>Name in Block letter(not more than 15 chars)</th>
<th>Sex(M/F)</th>
<th>Age</th>
<th>Concession/TravelAuthority No.</th>
<th>Choice if any</th>
</tr>
<tr>
<td>1.</td>
<td><input type="text" class="bh" /> </td>
<td>
<select name="sex">
<option value="M">M</option>
<option value="F">F</option>
</select>
</td>
<td><input type="number" value="20" max="110" class="bh" /></td>
<td><input type="text" class="bh" /></td>
<td rowspan="6" >Lower/Upper berth<br>Veg./Non-veg. Meal for Rajdhani/ Shatabdi Express Only</td>
</tr>
<tr>
<td>2.</td>
<td><input type="text" class="bh" /> </td>
<td>
<select name="sex">
<option value="M">M</option>
<option value="F">F</option>
</select>
</td>
<td><input type="number" value="20" max="110" class="bh" /></td>
<td><input type="text" class="bh" /></td>
</tr>
<tr>
<td>3.</td>
<td><input type="text" class="bh" /> </td>
<td>
<select name="sex">
<option value="M">M</option>
<option value="F">F</option>
</select>
</td>
<td><input type="number" value="20" max="110" class="bh" /></td>
<td><input type="text" class="bh" /></td>
</tr>
<tr>
<td>4.</td>
<td><input type="text" class="bh" /> </td>
<td>
<select name="sex">
<option value="M">M</option>
<option value="F">F</option>
</select>
</td>
<td><input type="number" value="20" max="110" class="bh" /></td>
<td><input type="text" class="bh" /></td>
</tr>
<tr>
<td>5.</td>
<td><input type="text" class="bh" /> </td>
<td>
<select name="sex">
<option value="M">M</option>
<option value="F">F</option>
</select>
</td>
<td><input type="number" value="20" max="110" class="bh" /></td>
<td><input type="text" class="bh" /></td>
</tr>
<tr>
<td>6.</td>
<td><input type="text" class="bh" /> </td>
<td>
<select name="sex">
<option value="M">M</option>
<option value="F">F</option>
</select>
</td>
<td><input type="number" value="20" max="110" class="bh" /></td>
<td><input type="text" class="bh" /></td>
</tr>
</tbody></table>
</div>
<p> CHILDREN BELOW 5 YEARS (FOR WHOM TICKET IS NOT TO BE ISSUED)</p>
<table class="t1">
<tbody>
<tr>
<th>S.No.</th>
<th>Name in Block letter</th>
<th>Sex(M/F)</th>
<th>Age</th>
</tr>
<tr>
<td>1.</td>
<td><input type="text" class="bh" /> </td>
<td>
<select name="sex">
<option value="M">M</option>
<option value="F">F</option>
</select>
</td>
<td><input type="number" value="2" max="6" class="bh" /></td>
</tr>
<tr>
<td>2.</td>
<td><input type="text" class="bh" /> </td>
<td>
<select name="sex">
<option value="M">M</option>
<option value="F">F</option>
</select>
</td>
<td><input type="number" value="2" max="6" class="bh" /></td>
</tr>
</tbody>
</table>
<div>
<p class="tc">ONWARD/RETURN JOURNEY DETAILS</p>
<div class="col">
<div class="ha">
<div class="fe">
<label for="">Train No & Name</label>
<input type="text" class="l">
</div>
<div class="fe">
<label for="">From</label>
<input type="text">
</div>
</div>
<div class="ha">
<div class="fe">
<label for="">Date</label>
<input type="date">
</div>
<div class="fe">
<label for="">To</label>
<input type="text">
</div>
</div>
<div class="fa">
<div class="fe">
<label for="">Name of applicant </label>
<input type="text" class="fu">
</div>
<div class="fe">
<label for="">Full address </label>
<input type="text" class="fu">
</div>
</div>
</div>
</div>
<hr />
<div class="col">
<p class="tc"><b>Signature of the Applicant/Representative</b></p>
<div class="mb-2 fc">Telephone No., if any <input type="text" class="fi"> Date <input type="text" class="fi"> Time <input type="time" class="fi"></div>
</div>
<hr />
<div class="col">
<p class="tc"><b><u>FOR OFFICE USE ONLY</u></b></p>
<div class="fc">S.No. of Requistion <input type="text" class="fi"> PNR No.<input type="text" class="fi"></div>
<div class="fc">Berth/Seat No.<input type="text" class="fi"> Amount collected <input type="text" class="fi"></div>
</div>
<hr>
<div class="col mb-2">
<div class="tc">Signature of Reservation Clerk</div>
<span><b>Note :</b></span>
<ol>
<li>Maximum permissible passengers is 6 per requisition.</li>
<li>One person can give one requisition form at a time.</li>
<li>Please check your ticket and balance amount before leaving the window.</li>
<li>Forms not properly filled or in illegible forms shall not be entertained.</li>
<li>Choice is subject to availability</li>
</ol>
<div class="tc">
<button type="reset">Reset</button>
<button type="submit">Submit</button>
</div>
</div>
</div>
</form>
</div>
</body>
</html>