IMPORTANT. Please complete the appropriate sections and boxes CLEARLY and in BLOCK CAPITALS.

YP15A

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APPLICATION FORM

RENEWALS

Please continue overleafD D M M Y Y Y YExpiry date of existing Railcard

Are you renewing your existing Railcard? Yes No

How many Railcards have you held in the past?

*Must be completed.Full-time employment Part-time employment Not in employment

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

First Name*

Surname*

Address*

Town*

Telephoneinc. codePostcode*

Mobile Phone

Title* D D M M Y Y Y YMr Mrs Miss Ms Other Date of Birth M FGender

Email is the most environmentally-friendly way for you to hear about Railcard news, renewals and all of our great offers.

Email address

(Please tick as appropriate)

MATURE STUDENTS ONLYAll students aged 26 years and over, in full-time education must complete this section. Your tutor, head tutor, head of department or a University/Collegeadministration staff member, needs to complete and sign below: I confirm that the applicant is a student attending University/College for over 15 hours perweek, for at least 20 weeks a year. I have signed and stamped the photo on the back.

University/College Stamp: Print name

Position

Name of University/College

Signature

Telephoneinc. code

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 Data Controller. We will contact you when your card is close to expiry.* From time to time your personal details may be used to send you relevant information as described below. If you do NOT wish to be contacted for other marketing purposes please tick the relevant boxes.I do NOT want to receive by Mail by Email by SMSRailcard information and offers Train Company offers and other rail-related services We would also like to share your information with third parties so that they may send you information about their products and services.If you do NOT want to receive this information by post, please tick here If you do want to receive this information by email or SMS, please tick here

FOR ISSUING OFFICE USE ONLY

Please return this form promptly. Refer to the online manual for details.

STATION OR TRAVEL AGENT STAMP:

Station/Agency NLC or Code No:

D D M M Y Y Y YCard Expiry Date:

D D M M Y Y Y YDate of Application:

Photocard No:

New Railcard No:

Before signing this declaration, it is important that you have read, understood and agree to the conditions shown in this leaflet. I have read, understood and agree to the conditions shown in this leaflet. I confirm that the details I have provided are correct and that I am aged between 16 and 25 years or a mature student.

Signature* Date D D M M Y Y Y Y

DECLARATION - TO BE COMPLETED BY ALL APPLICANTS

YP15A

*Provided we hold valid contact details.

*Must be completed.