TOUR BOOKING FORM Departure Date: 21 FEBRUARY 2018

NO FIRST NAME LAST NAME DATE OF BIRTH GENDER PASSPORT EXPIRED DATE NATIONALITY ROOM LIST ADULT / CNB /
(disi dengan huruf besar) (disi dengan huruf besar & (DD-MM-YYYY) (M/F) (DD-MM-YYYY) (MY/SG) CWB/ INFANT
tanpa bin atau binti)
1 NUR SYAHIRA MOHD RUSMI 10-01-1995 F A39206399 31-10-2021 MY ROOM 1 ADULT
3
4
5
6
7
8
9
10

Address: Emergency Contact Details (for everyone above) Known Medical Conditions
CC 203 NO 2 Name: MOHD RUSMI (State any non-swimmers here)
JALAN PINGGIRAN 3/1, Relationship : Father Ms xxx
PINGGIRAN BATU CAVES Address: CC 203 NO 2 JALAN PINGGIRAN
68100 GOMBAK SELANGOR. 3/1 BATU CAVES 68100 GOMBAK SELANGOR

Any medical required

Tel. No. (HP): 0133304610 Post/Zip Code: 68100 No
Tel. No. (work): 03-61859513 Tel. No. (home): 0133019281/ 03-61859513
E-mail: nursyahirarusmi@gmail.com E-mail: -

Declaration Sign & Date:

I have read, understood, and accept the booking conditions provided on the Muslimtravelbug Sdn Bhd or 17 January 2018
associated website and attached, on behalf of all members of my party, by whom I am authorized to make this syahira
agreement. I enclose the deposit (as detailed), which is non-refundable in the event of my cancellation. Sign here
REMARKS;
Please attached this booking form with your passport copy for our attention.