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Partial ETR Exchange
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Void Auxillary Segments(?)
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Car
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Does this ticket have commission?
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Yes
No
Unknown
If Yes, what is the amount or %?
Approval Required to apply this ticket?
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Yes
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If YES, please explain.
OSI Information
Waiver Information
Re-Issue/Travel By
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MM slash DD slash YYYY
ETR/Information
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Original Issue Date
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Remaining Value of Ticket after Penalty
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Max. Day
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Yes
No
If Yes, how many days?
Expiration Date
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MM slash DD slash YYYY
Route Specific?
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Yes
No
Fare Breakdown
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Additional Comments
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Max. file size: 256 MB.
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