PT ALBALAD BERKAH INDONESIA

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FORMULIR PENDAFTARAN UMRAH
Cabang:

1. No. Kartu Identitas : ................................................................................................................................................

2. No. Paspor : ................................................................................................................................................
3. Nama Lengkap : ................................................................................................................................................
Sesuai Paspor
4. Nama Ayah Kandung : ................................................................................................................................................
5. Tempat Tgl Lahir : ...........................................................................................................Tgl : ....../......./.............
6. Umur : ............. tahun
7. Jenis kelamin : Pria Wanita
8. Status perkawinan : Belum Menikah Menikah Janda Duda
9. Alamat : ................................................................................................................................................
: ................................................................................................................................................
: ................................................................................................................................................
No. Telepon Rumah : .................................................... Hp : ................................................
10. Nama Orang Dekat : ................................................................................................................................................
Yang bisa dihubungi
11. Alamat : ................................................................................................................................................
: ................................................................................................................................................
No. Telepon Rumah : .................................................... Hp : ................................................
12. Nama Ahli Waris : ........................................................ Hubungan dg Ahli Waris : ..........................................
13. Alamat : ................................................................................................................................................
: ................................................................................................................................................
No. Telepon Rumah : .................................................... Hp : ................................................
14. Keberangkatan Tgl. : .......... / .......... / ................
15. Paket Umrah : Reguler Plus
16. Pesawat : MH SV Garuda .. .......
17. Hotel : Bintang 3 Bintang 4 Bintang 5

Persyaratan : Copy KTP, Buku Nikah,, Pasfto 4x6 tampak wajah (3 lembar), Kartu Keluarga, Paspor, Buku Kuning, Biometric (VHS)

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Calon Jamaah Umrah
PT ALBALAD BERKAH INDONESIA
Ruko Al Balad Kp. Kadu RT.002 RW.002 Desa. Kadu, Kec. Curug, Kab. Tangerang, Telp. 021-55661335