Flight Information Form

Full Name (As It Appears On Passport)*

TitleFirst NameLast NameSuffix
E-mail*
example@example.com
Phone Number*

Area CodePhone Number
Departure Date & Time (If not a direct flight, only provide info for flight to destination)*

MonthDayYear
DateHourMinutesAM/PM Option
Airline*
Departure Flight Number*
Arrival Time At Destination

:HourMinutesAM/PM Option
Arrival Time At Destination*
Return Date & Time*

MonthDayYear
DateHourMinutesAM/PM Option
Airline*
Return Flight Number*
Notes
Put any information related to your flight that isn't asked above.
By signing below, you acknowledge that all information that you have provided regarding your flight(s) is correct. If any of the information provided is incorrect, you acknowledge that you will accept all liabilites and be responsible for any fees that may occur to correct the information. LOT's Travel Affair is not to be held liable for any information provided by client.
Client Signature*

Clear
Should be Empty: