390 Victoria Street #01-26 Golden Landmark
Singapore 188061 
Tel: 62992345 Fax: 62991235
Email: shahidahtravel@pacific.net.sg

 

Registration Form Name : Registration MUIS No (if applicable):  Pakej Chosen : Address : Postal Code :    Telephone No (hm) : Email :        Telephone No (o) : Gender :     Male Female                                  Date of Birth : Status :  Belum Berkahwin Berkahwin Berpisah Janda/Duda    Blood Type : Passport Details Passport No:     Date of Issue : Nationality :    Singaporean Malaysian Other nationality Date of expiry  : Other Details Mother's name :                          (for visa applications) Have you went for Haj before this?   Yes No                                                 Year :  Have you travel with Shahidah for umrah/haj before?  Yes No                                                 Year :  Health information (eg : diabetes , high blood etc) Drug Allergy (if applicable) : Next of Kin Details Name of next of kin :  Address :          Postal code :          Relationship :    Telephone No (hm) :  Telephone No (hp) :