GIBS RMB 80 Degrees

First Name
As per passport

Middle Names
As per passsport

Surname
As per passsport

Preferred Name

Title

Date Of Birth

Physical Address

Contact Number
During work hours

Cell Number

Email Address

Nationality

Country of Issue

Passport Number

Passport Date of Issue

Passport Date of Expiry

Upload Your Passport

Emergency Contact Name

Emergency Contact Number

Emergency Contact Relationship to Delegate

Medical Conditions

Allergies

Dietary Requirements (Land)

Dietary Requirements (Air)

Seating Preference

Please note seating requests are not guaranteed as they are at the discretion of the airline

Do You Want To Fly Business Class

Yes No

Please note: Upgrades to business class must be paid within 48 hours.

Frequent Flyer Number
If Applicable

Frequent Flyer Airline
If Applicable

Do You Want To Extend Your Stay

Yes No

Please note: Breakaways may incur additional costs for your own account.

Additional Comments