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Newcomers : fullfill step 1 and step 2
Already raptim’s customer : fullfill only step 2
(* these fields must be filled out)
 

Step 1 - ELIGIBILITY REQUEST FORM
(for newcomers only)
my name : *
first names : *
date of birth :
(dd/mm/yy)
country of origin

I will travel for the following organization :
(RAPTIM feels free to request credentials in writing
before issuing “NGO rate” tickets)
Name of organization
(in full) : *
Active in the following field: *


Full address : *

  
• Building, street & n°
• Area code
• City
• Country
   
Telephone : *
Fax :
E.mail :

The person authorizing
my travel is :
His/her function within the organization :

Step 2 - TICKET COST ESTIMATE
my name : *
first names : *

(in the same order as on your passport)


Full address : *

  
• Building, street & n°
• Area code
• City
• Country
   
Telephone : *
Fax :
E.mail :
   
Accompanied by : persons
   
Name :
First Names :
date of birth :
(dd/mm/yy)
(when special rates for juniors/seniors apply)
   
Name :
First Names :
date of birth :
(dd/mm/yy)
(when special rates for juniors/seniors apply)
   

ITINERARY

From : *

  
• city
• airport
• departure date
(dd/mm/yy)

To : *

  
• city
• airport

If several stops/segments are envisaged,
please fill out a new field for each segment

Continuation to :		  
• city
• airport
• departure date
(dd/mm/yy)

Continuation to :		  
• city
• airport
• departure date
(dd/mm/yy)

Continuation to :		  
• city
• airport
• departure date
(dd/mm/yy)

Return from : *		  
• city
• airport

Return to : *		  
• city
• airport
• return date
(dd/mm/yy)

 
Class :
  
First :
Business:
Economy :

 
If cheaper rates
available I am willing
to leave : 		day(s) earlier
day(s) later
   
   

Your remarks and requests to your travel agent :

IMPORTANT: Please check !

• if your passport is valid 6 months beyond your stay
• if you need a visa and/or a specific vaccination
• if you wish a travel, assistance and/or luggage insurance

Your additional remarks :


send the formular :