BOOKING Request for Dependents

Request for Travel on UN ___________________ No. UN - ________________

For Travel of Dependents accompanying a Staff member

FROM (Agency): ________________________ Location: _____________________________

Name: _________________________________ Title: _________________________________

Date: ________________________ Signature: _____________________________

 

PART -1 TO: WFP-HAS

 

Please book our following staff member and his/her dependants on UN _____________.  We agree to pay the cost contribution(s) in cash/cheque. In the event we do not cancel this request by 12:00 hour ( noon ) the day before the flight, we abide by your regulations of flight cancellations.

STAFF member’s NAME NATIONALITY ROUTING DATE

_______________________ ___________________ _______________________            _________________

Dependent’s NAME RELATIONSHIP AGE

_______________________ ___________________ _______________________

_______________________ ___________________ _______________________

_______________________ ___________________ _______________________

_______________________ ___________________ _______________________

_______________________ ___________________ _______________________

Mode of payment: By AGENCY:             YES              NO               Amount US $ ________________________

 

By INDIVIDUAL:       YES              NO Amount US $ ________________________

 

Billing Address: ____________________________________________________________________________

Passenger’s Address/Tel: Office & Residence: ____________________________________________________

   ____________________________________________________

   ____________________________________________________

 

Approved/Disapproved

Date: _____________________ _ Coordinator: ____________________________

 

Requesting Agency to retain a copy, one copy to WFP-HAS