Name:

Sex:

Email ID:

No of people:

City from which you will fly with Druk Air into Bhutan:

Will you need assistance in arranging travel to one of these cities:

Total number of days you want to spend in Bhutan:

Arrival date in Bhutan:

Departure date from Bhutan:

Permanent Address:

Phone Number:

Place of Birth:

Date of Birth:

Nationality:

Nature of Passport:

Passport number:

Date of issue:

Place of issue:

Date of expiration:

Occupation/ Profession:

Date of visit:

Details of earlier visits, if any: