TO WHOM IT MAY CONCERN:

I HEREBY AUTHORIZE _____________________________________________________________________________
TO DEBIT MY CREDIT CARD AS FOLLOWS:

TYPE OF CARD: __________________________________________________________________________________

ISSUED BY:______________________________________________________________________________________

CARD NO: ___________________________________    EXPIRY DATE :_____________________________________

NAME OF CARD HOLDER :__________________________________________________________________________

DATE OF BIRTH :______________________________     PASSPORT NO :____________________________________

COUNTRY OF ISSUE :_______________________   DATE OF EXPIRY : ______________________________________

LOCAL ADDRESS : _______________________________________________________________________________

_______________________________________________________________________________________________

TEL: OFF: _____________________________________  FAX: ____________________________________________

HOME: _______________________________________   CELL: ___________________________________________

AMOUNT TO BE DEBITED (IN FIGURES) CURRENCY: _____________________________________________________

AMOUNT IN WORDS: ______________________________________________________________________________




SIGNATURE: __________________________________   DATE:___________________________________________


DECLARATION: I HAVE PERSONALLY READ THE ABOVE FORM & FULLY UNDERSTAND & ACCEPT THAT BY THE ABOVE AUTHORISED SIGNATURE MY CREDIT CARD WILL BE DEBITED FOR THE QUOTED AMOUNT PLUS VAT AS APPLICABLE. / I ALSO ACCEPT AGAINST THE ABOVE MENTIONED TOUR COST/HOTEL STAY SHOULD ANY AMMENDMENTS OR CHANGES/CANCELLATION BE MADE TO A CONFIRMED TOUR PROGRAMME, THIS WILL BE SUBJECT TO CANCELLATION FEE & SERVICE CHARGE BEING LEVIED. A COPY OF MY CREDIT CARD IS ALSO ENCLOSED FOR THIS PURPOSE. IF FOR SOME REASON I SHOULD CANCEL MY TRAVEL/TOUR/HOTEL BOOKING, THIOS DOCUMENT AUTHORISES THE RECIPIENTOF THIS CREDIT CARD – AUTHORISATION FORM IE : TRAVEL AGENT/TOUR OPERATOR/HOTEL/TRANSPORTER TO DEBIT ME/MY CARD FOR THE APPLICABLE CANCELLATION AMOUNT FOR THE SERVICES BOOKED & CONFIMEDAS PER BOOKINGS GIVEN BY MYSELF/MY AGENT ON MY BEHALF.