Surname:

First Name:

Date of Birth:

Address:

Nationality:

Occupation:

Passport No.:

Place & Date of Issue:

Expiry Date:

Tel. No. (Res.):

Tel. No. (Off.):

Fax:

Email:

Mobile:

Arrival Date:

Flight No.:

Departure Date:

Flight No.:

Name:

Address:

Tel. No. (Res.) :

Tel. No. (Off.):

Fax:

Email:

Mobile:

Please reserve a seat for Kailash - Mansarovar pilgrimage trip leaving Kathmandu in May/June/July/August ____, 200_. I agree to abide by all the terms and conditions of DYM -Nepal. I enclose herewith:

• The registration fees US$ / INR ______with 3 Passport size photos.
• Photocopy of the passport with all details mentioned above or obtaining Visa.
• Duly signed Risk and Liabilities form to confirm my booking.