Prepaid Migrant Travel: Case Detail Sheet

IOM CASE DETAIL SHEET

City of Departure: Country of Departure: City of Arrival: Country of Arrival:

Passenger(s) Travel Document Gen DOB Relation-ship SURNAME Other Names Citizenship Number (DD/MM/YY) to PA and expiry date PA

If you have more family member, please tick the box and complete the remaining family members in the Page 2. ☐ Traveller’s Details: *Initial Entry By Date *Immigration File Reference Number (F, OSF, BCC): on Visa: Current Address or the name of Camp: Current Telephone No: Email:

Proposer’s details in Australia (if any): Name: Relationship: Address: Daytime Email: Phone: Mobile:

Affiliate/Secondary contact details other than the proposer (mandatory for loan cases):

Remarks: Preferred period of travel: Special Request (if any):

FOR OFFICE USE ONLY PF:

Project ID:

Case Size:

IOM Case Detail Sheet (no lkp) Ver. 2015_08 Payment method: ☐ Bank cheque or ☐ EFT (Australian $) ☐ EFT (US $) ☐ Others (please specify) Money Order

Additional passenger(s):

Travel Document Gen DOB Relation-ship SURNAME Other Names Citizenship Number (DD/MM/YY) to PA and expiry date

FOR OFFICE USE ONLY PF:

Project ID:

Case Size:

IOM Case Detail Sheet (no lkp) Ver. 2015_08