Uniworld Passenger Information Form – Fill Out and Use This PDF

MANDATORY PASSENGER INFORMATION FORM

Due to immigration and security measures worldwide, passenger information must be fully completed and received by Uniworld by the time of inal payment. Final documentation will not be processed without receipt of the passenger information form. One (1) completed form is required per passenger.

First name, middle name (if applicable), and last name must be entered exactly as they are shown on the passenger’s passport. Please fax the completed form to (818) 382-7655. Or, you may mail it to Uniworld Boutique River Cruise Collection, Attn: Guest Services, 17323 Ventura Blvd, 2nd Fl, Los Angeles, CA 91316.

Booking Number	Cruise/Tour Date		Cruise/Tour Name	Departure Date		Departure City
	/	/		/	/

PASSENGER INFORMATION A valid passport is required for all UNIWORLD programs. Passport must be valid for 6 months after return to the US.

c Mr. c Mrs. c Ms. c Dr.	Gender
	c Male

_______________________________________ _______________________________ ___________________________ _______ /_______ /_______ c Female

Last Name	First Name	Middle Name	Date of Birth (mm/dd/yy)
____________________________	_________________________________	________________________	_______ /_______ /_______	_______ /_______ /_______
Country of Citizenship	Passport Number	Country of Issue	Date of Issue (mm/dd/yy)	Expiration Date (mm/dd/yy)

Do you have any medical or physical limitations that would prevent you from enjoying shore excursions with walking tours? (For example, use of a wheelchair, cane, or walker.)

c Yes c No If yes, please explain: __________________________________________________________________________________________________________

Do you have any special dietary requests?	Yes c No c If yes, please explain: _____________________________________________________________________
Have you traveled with Uniworld before?	Yes c No c

cPlease check here if you would like to receive further communications from Uniworld. Refer to our website, www.uniworld.com/privacy.asp, for our privacy policy.

PERMANENT ADDRESS

________________________________________________ ____________________________________ ______________ ______________ _________________________

Street AddressCityState/Province Zip/Postal Code Country

( _____ ) ____________________________________ ( _____ ) _____________________________________ ____________________________________________________
Home Phone	Mobile/Business Phone	E-mail Address (required for conirmation)

EMERGENCY CONTACT INFORMATION (Name of a person not traveling with you)

c Mr. c Mrs. c Ms. c Dr. ____________________________________________________	_____________________________________________________
Last Name	First Name

________________________________________________ ____________________________________ ______________ ______________ _________________________

Street Address	City	State/Province	Zip/Postal Code Country
( _____ ) _____________________________________	( _____ ) ______________________________________ __________________________________________________
Home Phone	Mobile/Business Phone	E-mail Address

For those passengers making their own light arrangements and who wish to take advantage of one of our transfer options, please contact your travel agent or Uniworld at 1-800-733-7820. Your light details should be given to Uniworld no later than 45 days prior to departure and the lights must conform to our Transfer Guidelines as shown in the Terms and Conditions of our current brochure and on our website.

TRAVEL PROTECTION PLAN

I have also been advised about UNIWORLD’s Travel Protection Plan.

c Accepted it c Declined it

CREDIT CARD AUTHORIZATION

By accepting below, I authorize UNIWORLD to charge my credit card for all speciic services which I have directly ordered and authorized to be booked according to the Terms & Conditions’ costs/deposits of my cruise/tour. I acknowledge that I have received, read and understood all Terms & Conditions of UNIWORLD as indicated in their current brochure or website at www.uniworld.com and agree to all of them, including cancellation penalties and change fees. I have read and understood this Passenger Information Form and requirements.

c Accept c Decline

0510-12

CST #2075415-20