OPTIONAL PRIVATE RAILWAY REFUND NOTE ISSUING CHANNEL / ORDER STATUS: ACTUAL PURCHASE TIME: INTENDED REQUEST TIME / ACTUAL RESULT TIME: FULL ORIGINAL DEPARTURE DATE / TIME / STATION / TRAIN: PREVIOUS CHANGE / TICKET PRODUCT / DAILY EXCEPTION ALLOWANCE: ORIGINAL PAYMENT METHOD: ACTUAL DISPLAYED REFUND / FEE / SEPARATE PROVIDER CHARGE: REQUEST ATTEMPTED / RAILWAY REFUND CONFIRMED / FUNDS RECEIVED: ACTUAL FOLLOW-UP CHANNEL / NEXT INSTRUCTION: This blank aid is not an official form, ticket or transaction. Keep private order, payment and document information off public direction copies.