ROFESSIONAL EXCHANGE PLATFORM

P.O.BOX 77370 DSM

Website. www.pexpla.com.
Email: Info@pexpla.com / placement@pexpla.com,
Contact: +255 746 957 949 / +255 757 481 664,
Africab building, 2nd Floor, Mivinjeni

INTERNATIONAL CONFERENCE REGISTRATION FORM Date: 16 Nov 2023

APPLICANT PERSONAL DETAILS

Full name: JANE MUDI

Year of birth: 1998 Moth: 06 Date: 02
Gender: MALE
National ID no: TAZHDUDHSB
Nationality: TANZANIAN Region: DAR ES SALAAM District: TEMEKE
Contact: +255689780452 Email: PROSPERSIMON54@GMAIL.COM

Choose the country to attend a conference

DUBAI CHINA ISRAEL TURKEY SOUTH AFRICA ETHIOPIA

- YES - - - -

To be filled by pexpla Manager

a) Travelling date...........................................................................

b) Company airline............................................................................

c) Flight name................................................................................

attachments

S/N attachment Status

1 4passport size
2 Passport bio data page YES Expire date
3 Visa YES Expire date
4 Pay slip YES Amount
5 Covid 19 vaccine YES
6 Yellow fever card YES
7 conference contract - Page 1
 ROFESSIONAL EXCHANGE PLATFORM
P.O.BOX 77370 DSM
Website. www.pexpla.com.
Email: Info@pexpla.com / placement@pexpla.com,
Contact: +255 746 957 949 / +255 757 481 664,
Africab building, 2nd Floor, Mivinjeni

Read carefully the following section and give correct response

Have you attended any conference organized by pexpla ? YES If yes,

Fill the following:

a) Country visited: HINA

b) Conference title: LEARN

c) Hotel attended: HOTEL DUBAI

d) Date travelled: 2023-11-13

e) Days spent 5

f) Date returned 2023-11-16

To be filled by pexpla officer

g) Amount paid ....................................................

h) Budget used ....................................................

Other Basic Information

i) Have you ever travelled to any foreign country? YES

ii) If "YES" tell Us which country have you ever travelled? KENYA

iii) Are you employed? YES

iv) What is your mission with this conference? TO LEARN

v) Do you have any health problem ( Yes / No ) YES

If "YES" Specify the specific heailth problem do you have? SLEEP

vi) Do you have Any special agreement from pexpla NO

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