| You are: |
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| Purpose of travel: |
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| VISITING DOMINICAN REPUBLIC - FLIGHT DETAILS |
| Is your flight to the Dominican Republic direct or does it include a layover? |
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| Departure airport: |
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| Flight date: |
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| Airline company: |
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| Flight number (ensure you enter the flight number, not the confirmation number) |
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| Transit airport: |
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| Connecting flight date: |
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| Connecting airline company: |
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| Connecting flight number: |
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| Arrival airport in the Dominican Republic: |
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| Date of Arrival in the Dominican Republic: |
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| ACCOMMODATION IN DOMINICAN REPUBLIC |
| How many days do you plan to stay in the country?: |
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| Accommodation Type: |
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| Name of hotel: |
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| Full address of accommodation: |
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| Province: |
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| Municipality (if known): |
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| Section (if known): |
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| Harbor: |
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| Destination country: |
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| Do you plan to practice one of the following sports activities during your stay:: |
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| DEPARTURE FROM THE DOMINICAN REPUBLIC |
| Airport of departure from the Dominican Republic: |
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| Departure from the Dominican Republic: |
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| Flight number: |
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| Airline company: |
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| Destination country: |
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| Airport of final destination: |
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| PERSONAL INFORMATION: |
| First names: |
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| Last names: |
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| Email address: |
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| Gender: |
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| Phone number (including country code): |
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| Date of birth: |
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| Country of birth: |
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| Home Address: |
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| City: |
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| Zip code / Postal code: |
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| Home Country: |
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| Passport Number: |
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| Passport issuing country: |
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| Civil status: |
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| Occupation: |
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| EXTRA VISITORS INFORMATION |
| Are you travelling alone? |
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| What is your relationship with the other travel members: |
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| Number of additional visitors: |
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| ADDITIONAL VISITOR 1 |
| First name: |
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| Last name: |
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| Date of birth: |
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| Country of birth: |
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| Gender: |
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| Passport Number: |
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| Passport issuing country: |
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| Civil status: |
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| Occupation: |
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| ADDITIONAL VISITOR 2 |
| First name: |
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| Last name: |
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| Date of birth: |
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| Country of birth: |
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| Gender: |
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| Passport Number: |
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| Passport Issuing Country: |
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| Civil status: |
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| Occupation: |
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| ADDITIONAL VISITOR 3 |
| First name: |
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| Last name: |
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| Date of birth: |
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| Country of birth: |
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| Passport Number: |
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| Gender: |
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| Passport Issuing Country: |
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| Civil status: |
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| Occupation: |
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| ADDITIONAL VISITOR 4 |
| First name: |
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| Last name: |
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| Date of birth: |
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| Country of birth: |
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| Gender: |
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| Passport Number: |
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| Passport Issuing Country: |
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| Civil status: |
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| Occupation: |
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| ADDITIONAL VISITOR 5 |
| First name: |
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| Last name: |
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| Date of birth: |
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| Country of birth: |
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| Gender: |
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| Passport Number: |
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| Passport Issuing Country: |
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| Civil status: |
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| Occupation: |
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| ADDITIONAL VISITOR 6 |
| First name: |
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| Last name: |
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| Date of birth: |
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| Country of birth: |
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| Gender: |
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| Passport Number: |
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| Passport Issuing Country: |
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| Civil status: |
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| Occupation: |
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| ENTRY INFORMATION |
| Are you filling in the Customs Form on behalf of a third party? |
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| Names: |
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| Relationship: |
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| Are you bringing currency or other payment instrument exceeding USD 10,000? |
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| Amount: |
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| Type of currency (e.g. EUR, USD, GBP): |
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| What is the origin of the securities: |
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| Are you the owner of the values? |
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| Sender first names: |
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| Sender last names: |
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| Receiver first names: |
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| Receiver last names: |
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| Relationship between traveler and sender/receiver: |
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| Purpose or destiny of the values: |
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| Are you bringing with you (including in the luggage or any other possessions of any member of your travel group) live animal(s) and/or plants, and/or food products? |
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| Are you bringing with you (including in the luggage or any other possessions of any member of your travel group) goods subject of tax payment? |
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