Adam Travel

 
 
 
 
 
 
 
 

Umrah Package Registration Form

Please fill in and submit the following registration form as a first step to applying for your Umrah package with Adam Travel Australia.
Please select your package: Package Name:
Please select the room occupancy that you require:
Package Price: Deposit:
Family Name (as in passport):  *
First Name (as in passport):  *
Middle Names (as in passport):
Profession:
Date of Birth (DD/MM/YYYY):  * Place of Birth:  *
Gender: Male Female  * Marital Status:  *
Previous Nationality:  * Present Nationality:  *
Passport Number:  * Place of Issue:  *
Date of Issue (DD/MM/YYYY):  * Date of Expiry (DD/MM/YYYY):  *
Home Address:  *
Telephone Number: Mobile:
Business Address:
Telephone Number: Email Address:  *
Name of Mahram (for females only): Relation to Mahram:
Mother's Name: Sect (Suuni, Shia, etc):
Medical History (If any): Blood Type:

IN CASE OF EMERGENCY, PLEASE CONTACT:
Full Name: Relationship:
Full Address: Telephone Number:
Name of Family/Friend accompanying you:

PAYMENT:
  DEPOSIT and FINAL PAYMENT
Payable To: ADAM TRAVEL PTY LTD
Bank: Commonwealth Bank of Australia
BSB No: 063-122
Account No: 10686701
Bank Address: 488 Sydney Rd, Coburg, VIC 3058

Seats are available on a ‘FIRST COME, FIRST SERVED” basis.
For Group Packages: Deposit of AU$1000 is required upon booking.
For Individual Packages: Deposit of AU$500 is required upon booking.

Declaration:
I hereby declare that I am a Muslim. I further declare that I am in good health to perform Umrah. I have read carefully, understood and agreed to the Terms and Conditions Agreement including the details of the Umrah package which I have selected. I enclose my deposits as stated and agree to pay the balance as agreed.

* I consent that I have read carefully, understood and agree to all the above.