Valued Clients Priority Guest DetailsYour Family PhotoAccepted file types: jpg, png, jpeg, bmp, Max. file size: 220 MB. PG No(Required)Date of Entry(Required) DD slash MM slash YYYY DETAILS OF GUEST 1Name(Required)Age(Required)Date of Birth(Required) DD slash MM slash YYYY Anniversary Date DD slash MM slash YYYY NIDPlease enter a number greater than or equal to 10.DETAILS OF GUEST 2Guest-2NIDAgeDate of Birth(Required) DD slash MM slash YYYY DependentsNumber of DependentsBoy/sGirl/sName of Dependent 1Date of Birth DD slash MM slash YYYY AgeName of Dependent 2Date of Birth DD slash MM slash YYYY AgeName of Dependent 3Date of Birth DD slash MM slash YYYY AgeContactsMobile No-1(Required)Mobile No-2(Required)Office NoEmail(Required) Home Address(Required) Street Address City ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean 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IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Application and AgreementDate of Applicaton(Required) DD slash MM slash YYYY Priority Guest Since(Required) DD slash MM slash YYYY Priority Guest Till(Required) DD slash MM slash YYYY Total Number of Years(Required) 5 10 Yearly Total Points(Required)Yearly AMC in USD(Required)Priority Guest Amount(Required)Admin and Legal Fees(Required)Total Cost(Required)Amount Paid(Required)Balance if Any(Required)Balance ModePayment Mode CASH CHQ CC DC OT EMI EMI 0M 3M 6M 9M 12M 18M 24M 36M Please tick the boxes I understand that the AMC is not included in total cost. AMC amountDue on. I understand that we are signing this agreement in the presence of Lawye and under CCTV coverage and the amount paid is non-refundable. I understand that we can only start using the points after full payment is made and yearly AMC received. RemarksDetails of the Points5 Years Slot10 Years Slot1st Year Point Details1st Year Point Details from DD slash MM slash YYYY 1st Year Point Details to DD slash MM slash YYYY Purchased(Required)Spent(Required)Balance(Required)AMC(Required) Paid Unpaid Not Applicable Exchange(Required) Paid Unpaid Not Applicable Tour Photo Drop files here or Select files Max. file size: 220 MB, Max. files: 3. 2nd Year Point Details2nd Year Point Details from DD slash MM slash YYYY 2nd Year Point Details to DD slash MM slash YYYY Purchased(Required)SpentBalance(Required)AMC Paid Unpaid Not Applicable Exchange Paid Unpaid Not Applicable Tour Photo Drop files here or Select files Max. file size: 220 MB, Max. files: 3. 3rd Year Point Details3rd Year Point Details from DD slash MM slash YYYY 3rd Year Point Details to DD slash MM slash YYYY PurchasedSpentBalanceAMC Paid Unpaid Not Applicable Exchange Paid Unpaid Not Applicable Tour Photo Drop files here or Select files Max. file size: 220 MB, Max. files: 3. 4th Year Point Details4th Year Point Details from DD slash MM slash YYYY 4th Year Point Details to DD slash MM slash YYYY PurchasedSpentBalance(Required)AMC Paid Unpaid Not Applicable Exchange Paid Unpaid Not Applicable Tour Photo Drop files here or Select files Max. file size: 220 MB, Max. files: 3. 5th Year Point Details5th Year Point Details from DD slash MM slash YYYY 5th Year Point Details to DD slash MM slash YYYY PurchasedSpentBalanceAMC Paid Unpaid Not Applicable Exchange Paid Unpaid Not Applicable Tour Photo Drop files here or Select files Max. file size: 220 MB, Max. files: 3. 6th Year Point Details6th Year Point Details from DD slash MM slash YYYY 6th Year Point Details to DD slash MM slash YYYY Purchased(Required)Spent(Required)Balance(Required)AMC Paid Unpaid Not Applicable Exchange Paid Unpaid Not Applicable Tour Photo Drop files here or Select files Max. file size: 220 MB, Max. files: 3. 7th Year Point Details7th Year Point Details from DD slash MM slash YYYY 7th Year Point Details to DD slash MM slash YYYY Purchased(Required)Spent(Required)Balance(Required)AMC Paid Unpaid Not Applicable Exchange Paid Unpaid Not Applicable Tour Photo Drop files here or Select files Max. file size: 220 MB, Max. files: 3. 8th Year Point Details8th Year Point Details from DD slash MM slash YYYY 8th Year Point Details to DD slash MM slash YYYY Purchased(Required)Spent(Required)Balance(Required)AMC Paid Unpaid Not Applicable Exchange Paid Unpaid Not Applicable Tour Photo Drop files here or Select files Max. file size: 220 MB, Max. files: 3. 9th Year Point Details9th Year Point Details from DD slash MM slash YYYY 9th Year Point Details to DD slash MM slash YYYY Purchased(Required)Spent(Required)Balance(Required)AMC Paid Unpaid Not Applicable Exchange Paid Unpaid Not Applicable Tour Photo Drop files here or Select files Max. file size: 220 MB, Max. files: 3. 10th Year Point Details10th Year Point Details from DD slash MM slash YYYY 10th Year Point Details to DD slash MM slash YYYY Purchased(Required)Spent(Required)Balance(Required)AMC Paid Unpaid Not Applicable Exchange Paid Unpaid Not Applicable Tour Photo Drop files here or Select files Max. file size: 220 MB, Max. files: 3. 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