REGISTRATION CARD RESERVATION

Guest Name : FOR FOREIGNERS ONLY

E-mail : Nationality :
Phone No. : Passport No. :
Address : Date of Issue / Expiry date :
Date of Arrival in Indonesia :
Visa No. :
Date of Issue / Expiry date :
Birthday : Whether Employed in Indonesia Yes No
Arrived From Proceeding to : Proposed Duration of stay in Indonesia :
Arrived Date : Time : FOR HOTEL USE :
Departure Date : Time : Room No. : Room Type :
Purpose of Visit : Tourist / Holiday Conference Room Rate :
Group Bussiness Adults : Children : Extra Bed :
Mode of Payment : Booked By :
Credit Card No. : Expiry Date : Billing Instruction / Address :
Terms and Condition :
1) Check in / Check out time is 12:00 Noon.
2) Extensions will be subjected to availability and rate adjustments and any Extensions of
stay must be reconfirmed with the Duty Manager.
3) Registered guests will be held responsible for any missing or damaged items in their
hotel room or any internal / external areas of hotel. This liability extends to both
registered guests and their visitors.
4) I have gone through the Terms and Conditions governing my stay in the hotel and agree
to abide by them.
GUEST SIGNATURE, RECEPTIONIST,