• REGISTRATION FORM

    REGISTRATION FORM

  • 1 JOO CHIAT COMPLEX #05-1007 S(420001)

  • PHOTO

  • 6348 3498 (Office) I 9006 7568 (Whatsapp)

  • 1 X PASSPORT PHOTO

  • Registration Form

  • Take Photo
  • Date
     - -
    2 digit day, 2 digit month, 4 digit year

  • Fill in all details sign (Delete if applicable)

     

  • WISATA

  • DEPARTURE DATE*
     / /
    2 digit day, 2 digit month, 4 digit year
  • Halal Friendly Tours & Packages :

  • PAX DETAILS

  • Date of Birth (DD MM YYYY format)*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Gender
  • Format: 0000-0000.

  • PASSPORT DETAILS

  • Date of Issue
     / /
    2 digit day, 2 digit month, 4 digit year
  • Date of Expiry*
     / /
    2 digit day, 2 digit month, 4 digit year

  • NEXT - OF - KIN DETAILS

  • SPECIAL REQUEST

  • WHEELCHAIR SERVICE :
  • ROOM TYPE

  • PAYMENT DETAILS

    (Official Use Only)
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  • 1. I, understand and certify that all information given are accurate and true at the time of registration. 2. I, understand that the travel agency reserve the right to use the information given for flight, visa and hotel bookings. 3. I, understand that the travel agency reserve the right to deduce admin and/or cancellation fee from the initial deposit.

    Payment Terms: Cash / Cheque / Paynow via UEN 200201971M

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