22. Rules 10 to 21 to be printed on coupon books.

Schedule
Form "A"
Form "A"
[ See Rule 9 (1l)(b)]
Statement of the journey undertaken by rail transit coupons used by the ex-members.
Statement of the journey undertaken by rail transit coupons used by the ex-members.
Serial No.
Railway Coupon Book No.
Date of Journey
From
To
(1)
(2)
(3)
(4)
(5)
Class by which travelled
Class in which the person accompanied him
travelled
Other particulars such as cancellation of journey
or the declaration of theft of coupons
(6)
(7)
(8)
Signature Ex-member of Legislative Assembly
(1)
Coupon book for travel within the State.
For the ex-member himself and person accompanying him worth
Rs..........
(2)
Coupon book for travel outside the State.
For the ex-member himself and person accompanying him worth
Rs............
Form "B"
Form "B"
(See proviso of Rule 3)