EmailMe Form - PASSENGER INFORMATION SHEET

PASSPORT DETAILS

Company *

Position Title

Department

Cost Centre

Passenger Name (As shown in passport)

Prefix First Middle Last

Mobile Number (including country code)

Landline

E-mail Address

Personal Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Passport No.

Copy of Passport

Passport Issue Date

DD / MM / YYYY

Passport Expiry Date

DD / MM / YYYY

Date of birth

DD / MM / YYYY

Country of passport

TRAVEL DETAILS

Seating Preference

Window

Aisle

Upper Deck

Main Deck

Airline Frequent Flyer Numbers (Airline and Number)
Please list all memberships

Hotel Card Numbers
Please list all memberships

Car Hire Memberships
Please list all memberships

Special meals (Vegetarian, kosher, etc)

Emergency Contact Name and Mobile number

PRIVACY STATEMENT

"I/We acknowledge that I/we will provide Spencer Travel Pty Ltd ('the Agent') from time to time with information about myself / ourselves of a personal nature (personal Information").

"I/We (Client) consent to 'the Agent' using any personal information supplied by me/us for the purposes of making and completing airline bookings and travel related arrangements on behalf of me /us".

Name

Prefix First Last

Signature

Clear

Date Time

DD / MM / YYYY