Vous êtes sur la page 1sur 3

Title : (Mr, Mrs, Ms etc.

) First name(s) : (Exactly as per passport) Surname: Date of Birth: Company: Primary email address:

Mr Thandolwethu Sipuye 15 June 1985 Gondwana Alive tsipuye@gmailc.om

Gender:

Male X

Female

Position/ob Title: Subscribe to goText


(to receive all your travel information as a text message on your mobile phone):

Communication Officer Yes X No

Work contact details


Work/Office number : Work/Office fax number : Work mobile number : Work email address : (Country Code -Area Code -Number)2721 783 3939 (Country Code -Area Code -Number)2786 587 2792 (Country Code -Area Code -Number)2782 702 4310 traceyphi@gmail.com

Personal contact details


Home number : Home fax number : Personal mobile number : Personal email address : (Country Code -Area Code -Number)N/A (Country Code -Area Code -Number)N/A (Country Code -Area Code -Number)2778 215 2529 tsipuye@gmail.com

Physical Work Address


Street name and number : Building/Complex name : 04 Stibitz Street The Place Westlake Business Park Suburb/Town : City : Zip code : Country : Steenberg Cape Town 7966 South Africa

Physical Home Address


Street name and number : Building/Complex name : Unit/Apartment number : Suburb/Town : City : Zip code : Country : South Africa 03 Pani Close KTC N/A Gugulethu Cape Town

Passport details (Clear copy of Passport / ID to be provided to Wings)


Passport (1) nationality: Passport (1) number: Date of issue: Expiry date: ID (1) number: Social Security (1) number: Passport (2) nationality: Passport (2) number: Date of issue: Expiry date: ID (2) number: Social Security (2) number:

Frequent Flyer / Loyalty Program details


Airline company: Airline company: Airline company: Membership number: Membership number: Membership number:

Car loyalty Program details


Car hire company: Car hire company: Membership number: Membership number:

Hotel loyalty Program details


Hotel chain: Hotel chain: Membership number: Membership number:

Other loyalty Program details


Other loyalty Program: Other loyalty Program: Membership number: Membership number:

Special seating requirements


Aisle seat X Window seat Bulkhead seat Upper deck Rear / tail cabin/compartment for unaccompanied minors Front of cabin / compartment Seat with facilities for handicapped/incapacitated

Special meal requirements - (please specify your special meal requirements, if applicable)
AVML BBML BLML CHML DBML FPML GFML HFML Asian vegetarian Hindu meal Infant / baby meal Bland meal Child meal Diabetic meal Fruit platter meal Gluten intolerant meal High fibre meal LPML LMSL MOML NLML ORML PRML RVML SFML Low protein meal Low sodium (salt) meal Moslem meal Low lactose meal Oriental meal Low purin meal Raw vegetarian meal Sea food meal

HNML KSML LCML LFML VJML

Hindu (non vegetarian)(meal specific) Kosher meal Low calorie meal Low cholesterol / low fat meal Vegetarian Jain Meal X

SPML VGML VLML

Special meal, specify food Vegetarian Vegan meal (non dairy) Vegetarian meal (Lacto-ovo)

* Please note that not all airlines will cater for your special meal requirements

Visa details
Visa number : Visa expiry date : Country of issue :

Other requirements/Additional information

Vous aimerez peut-être aussi