Effective: August 2004

Last Updated: Jan2010

Holiday Tours and Travel Sdn Bhd.

(CO No. 23070-H) KKKP No. 0424
A-0-1, Block A, (General) : 603 – 6286 6000
No.1, Jalan Seri Utara 1, Sri Utara, (Corporate Leisure):603 – 6286 6129
Off Jalan Ipoh 68100 Kuala Lumpur
Malaysia

Traveller Profile Form Email Completed Form To:

Note: Use the ‘Tab’ key to move from field to field. Mandatory fields are in * RED
Company Information

*Company Name: Company Division:

Traveler Information

IMPORTANT: Enter name details EXACTLY as they appear on your passport

*Surname (family name): Title: Mr
*Given Names (first & middle names): Gender: Male
*Business Address (ticket delivery): *City:

*State: *Postal Code: *Country:

*Business Phone: *Email Address:
*Mobile Number: Residential Phone: Fax Number:
Residential Address: City:

State: Postal Code: Country:

Travel Arranger’s Name: Arranger’s Phone:
Arranger’s Email: Arranger’s Fax:
Job Title: Employee ID #:
Supervisor/Line Manager Name: Supervisor/Line Manager Phone:
Supervisor/Line Manager Email:
*Contact in case of emergency - Name:
*Emergency Contact Phone: Relationship to traveler:

Traveler Information

Seat Preference: Aisle | Seat Location: Forward

Special Seat Requirements:
Special Flight Requirements: | Special Meal Request: NONE
Frequent Flyer Information:
Airline: Membership Number: | Airline: Membership Number:
Airline: Membership Number: | Airline: Membership Number:
Airline: Membership Number: | Airline: Membership Number:

727644638.doc [120303cwtap] Page 1

 Effective: August 2004
Last Updated: Jan2010

Hotel Information

Bed Type Preference: Double/King Smoking Preference: Non-smoking

Special Hotel Requirements:
Memberships:
Hotel: Membership Number: | Hotel: Membership Number:
Hotel: Membership Number: | Hotel: Membership Number:

Car Information

Size Preference: Luxury Car Transmission: Select One Smoking Preference: Non-smoking
Memberships
Car Company: Membership Number: Car Company: Membership Number:
Car Company: Membership Number: Car Company: Membership Number:

Travel Document Information

Passport Information
*Passport Number: *Expiration Date (DD/MMM/YYYY):
*Country of Issue: *Date of Issue (DD/MMM/YYYY): *Date of Birth (DD/MMM/YYYY):
*Nationality: *Citizenship: *Residence:
National ID Number: (if applicable)

** Additional Passport Information (if any):

Passport Number: Expiration Date (DD/MM/YYYY):
Country of Issue: Date of Issue (DD/MM/YYYY): Nationality:

Visa Information
Do you hold any country Visas? : Select One. If yes, please specify:
Country: | Type: Select One | Valid for entries (99:Multi-Entries)| Expiration Date (DD/MMM/YYYY):
Country: | Type: Select One | Valid for entries (99:Multi-Entries)| Expiration Date (DD/MMM/YYYY):
Country: | Type: Select One | Valid for entries (99:Multi-Entries)| Expiration Date (DD/MMM/YYYY):
Country: | Type: Select One | Valid for entries (99:Multi-Entries)| Expiration Date (DD/MMM/YYYY):

Corporate Credit Card Information

Name as it appears on Credit Card:

Card Type: Select One Card Number: Expiration Date (01/MMM/YYYY):
I hereby authorize the Carlson Wagonlit Travel to charge any travel services requested by me or my authorized travel
arranger by telephone, mail, email, or facsimile to my (above) Credit Card account.
Cardholder Signature: ____________________________________________ Date:

727644638.doc [120303cwtap] Page 2

 Effective: August 2004
Last Updated: Jan2010

Family Information (Spouse)

IMPORTANT: Enter name details EXACTLY as they appear on your passport

*Surname (family name): Title: Select Title
*Given Names (first & middle names): Gender: Male

Airline Information

Seat Preference: Aisle | Seat Location: Forward |

Special Seat Requirements:
Special Flight Requirements: | Special Meal Request: NONE
Frequent Flyer Information:
Airline: Membership Number: | Airline: Membership Number:
Airline: Membership Number: | Airline: Membership Number:
Airline: Membership Number: | Airline: Membership Number:

Family Information (Children)

*Surname (family name): Title: Select Title

*Given Names (first & middle names): Gender: Male

Airline Information

Special Flight Requirements:

Special Meal Request: NONE
Frequent Flyer Information:
Airline: Membership Number: | Airline: Membership Number:
Airline: Membership Number: | Airline: Membership Number:

Family Information (Children)

*Surname (family name): Title: Select Title

*Given Names (first & middle names): Gender: Male

Airline Information

Special Flight Requirements: |

Special Meal Request: NONE
Frequent Flyer Information:
Airline: Membership Number: | Airline: Membership Number:
Airline: Membership Number: | Airline: Membership Number:

727644638.doc [120303cwtap] Page 3

 Effective: August 2004
Last Updated: Jan2010

727644638.doc [120303cwtap] Page 4