Citi-World Travelmart - The World At Its Best


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On-line Booking Form

- All sections and boxes marked with an asterisk (*) must be completed in order for us to process your request.

E-mail: info@citiworldtravel.com

(*)Required fields

Tour name:

*Start date [DD/MM/YY]:

- -

*Number in Party:

Documents to be Sent to:

*First Name:

*Last Name:

*Address:

*Phone number:

*E-mail Address:

Passenger Details

*Title:

(Mr, Mrs)

*Last Name:

*First Name:

*Passport Number:

*Country of Issue:

*Date of Issue:

*Nationality:

*Date of Expiry:

*Date of Birth:

*Place of Birth:

Your Journey Mob. Number:

Details of additional passenger (if applicable)

Title:	Surname	First Name

Title:	Surname	First Name

Title:	Surname	First Name

Room Details* (tick your choice)

I would like a :

double room with double bed

double room with twin beds

single room

other:

Other services (check your choice)

in-out transfers		add your cruise
private car and driver		sunbathing & swimming
car rent		spa & wellness treatments
travel assistant for the entire journey

other:

Details of Insurance Cover

*We confirm that I/we have adequate insurance cover:	Yes	No
Insurance Company Name:
Policy Number:
Medical Emergency Telephone Number:
Emergency contact whilst travelling with Citi-World Travelmart:
Telephone:
Relationship:

Diet, Allergies and Health*

Do you have any dietary restrictions or relevant medical conditions:

Yes

Details:

Is there any other information you think we should know?

*Terms and Conditions

I confirm that I am over 18 years of age, have read and understood the booking and general conditions and accept them on behalf of myself and the other passengers mentioned.

Click the Submit button to send us your completed on-line booking form.

Click the Reset button if you wish to delete all your information and restart.

Phone: (800) 552-1658 - Fax: (626) 820-1131 - info@citiworldtravel.com

Los Angeles
3048 Hacienda Blvd.
Hacienda Heights, CA 91745
T: 800.552.1658 | 626.820.1717
F: 626.820.1717
E: info@citiworldtravel.com
URL: www.citiworldtravel.com

Mumbai
C/5 Hariom Apartment, Bldg # 1.
S.V. Road, Borivali (W),
Mumbai-400 092, India.
T: 91-9869703935
E: info@pkttours.com
URL: www.pkttours.com