FAULTY AND STOLEN REPLACEMENT FORM –

* - 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*

Work Email

Reason for Replacement

Replacement Reason:*

EVIDENCE SUPPLIED* The relevant evidence must be supplied to allow a replacement to be issued

Stolen - For stolen cards a crime number must be included.

Crime Reference No.

Faulty - For faulty cards a clear colour image (front and back) of the card must be attached. If the photo of the faulty card shows visible damage please complete the Lost/Damaged form.

Faulty Card Images

Fire/Flood Damage - For fire/flood damage a report must be attached.

Fire/Flood Report

Replacement Information

Where cards contain boxes, then the replacement number of boxes will be issued on a pro-rata basis calculated in accordance with the card’s terms and conditions.

Declaration*

By checking this box:By submitting this form:

I confirm that all details provided are correct.
I understand that I am responsible for the correct use of my 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.
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 - Faulty and Stolen XX34 - This form is not valid for use after 31/03/2024

Once completed save the form with a filename of “YourLastname_Your Firstname_XX34_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