Insurance Form
Eco Penang Tour Sdn Bhd
 

   
   INSURANCE COVERAGE FORM  


 

 

 

 

 

 

 

 

 

 



 

     
 

CRUISE BOOKING INFORMATION

 
 

Date of Cruise (mm/dd/yyyy)

 
 
Click Here to Pick Date from Calendar
 
 
  Passengers for Boat Number :  
           
  Email Address used during Booking  
   
  Paypal Payment ID  
   
     
     
NOTE : If you don't have all the particulars for the passengers now,  fill in as many as possible and the remaining can be submitted later,  24 hours before the date of Cruise. Minimum one entry at the time provided with the Booking Information above.

**The Traveler's list entry below will be email to you at above specified email address as well.
 
PASSENGERS INFORMATION - INSURANCE FORM
     
Traveler 1 Traveler 2 Traveler 3
Full Name of Traveller Full Name of Traveller Full Name of Traveller
Nationality Nationality Nationality
Age Age Age
Passport / IC Number Passport / IC Number Passport / IC Number


Traveler 4


Traveler 5


Traveler 6
Full Name of Traveller Full Name of Traveller Full Name of Traveller
Nationality Nationality Nationality
Age Age Age
Passport / IC Number Passport / IC Number Passport / IC Number

 

Traveler 7 Traveler 8 Traveler 9
Full Name of Traveller Full Name of Traveller Full Name of Traveller
Nationality Nationality Nationality
Age Age Age
Passport / IC Number Passport / IC Number Passport / IC Number

 

Traveler 10
Full Name of Traveller
Nationality
Age
Passport / IC Number
                                            Click Here to Submit the Form  
 

 

 
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