Your Info :: Nelson Travel Broker

Traveller's Information Form

Group name (if relevant)

TItle Required

Surname Required

First Names Required

Post Code Required

Email Required

Postal Address Required

Phone (Day)

Phone (Evening)

Phone (Mobile) Required

Next of Kin

Kin Phone (Home)

Kin Phone (Work)

Passport Nationality

Passport Number

Passport Issued At

Passport Issued Date

Passport Expiry Date

Date of Birth Required

Place of Birth

NZ Returning Resident Visa?

Mobility or Health Issues Required

Please specify any mobility or health issues

Medical Conditions

Specify Medical Conditions

Specify Medical Conditions

Special Meal Requirements?

Specify Meal Requirements

Any Criminal Convictions

Specify Criminal Convictions

Frequent Flyer Member?

Airline 1

Membership/PIN 1

Airline 2

Membership/PIN 2

Any other comments