United Travel & Health Guardian

Agent Registration

*Agent Name:

Agent Address:

Agent Office No:

Agent Fax No:

*Agent Mobile No:

*Agent Email:

Agent NT No:

User Type:

*Parent Agent:

Agent Type:

IATA NON IATA

*Sale Agent:

Date of Opening ID:

Date of Establish:

DETAILS OF OWNER/PARTNERS/ DIRECTORS

*Name:

Address:

Office No:

Res No:

Mobile No:

Fax No:

NT No:

*Email:

*NIC No:

Passport No:

*Corporate Status:

Credit Limit:

Commission Slab: