GOVERNMENT TRAVEL AGENT REGISTRATION FORM
AGENCY NAME:
IATA NO: M.O.F REGISTRATION NO: ADDRESS:
KPL/LN NO: BUMITRA MEMBERSHIP NO:
PERSON IN CHARGE: DESIGNATION: EMAIL ADDRESS: CONTACT NO: FAX NO:
BANK DETAILS FOR COMMISSION BENEFICIARY NAME: BANK NAME: BANK ADDRESS:
BANK ACCOUNT NO: SWIFT CODE: I hereby declare that I have read and agreed to AirAsia's Travel Agent Terms and Conditions. I also declare that the information I have provided above is true and correct, to the best of my knowledge and belief. *Please ensure that all details required are completed in order for the registration to be processed Please provide hard copies of KPL/LN, KEMENTERIAN KEWANGAN MALAYSIA, BUMITRA SIJIL and your business card attached with this form. Please send it to: Cik Aziawati (Finance Department), AirAsia Berhad, LCC Terminal, Jalan KLIA S3, Southern Support Zone, 64000 Sepang, Selangor. Tel no: 03-86604068 and Fax no: 03-87751689.