Air Moldova :: Application form for private person

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Application form for private person

Application form for private person

All fields are required. In case of no data insert a through-line please. Write down your surname, name and additional name the same way as it is written in your international passport. Air Moldova will not disclose to third parties any personal information from the application form.

Personal Details

GENDER: Male Female

FIRST NAME:

LAST NAME:

ADDITIONAL NAME:

PASSPORT NUMBER:

DATE OF BIRTH:

NATIONALITY:

To become a member you must be over 12 year old

Contact details

ADDRESS: Home address Business address

COUNTRY:

CITY:

POST CODE:

STREET:

HOUSE Nr.:

APARTMENT Nr.:

E-MAIL:

TELEPHONE:

PLEASE NOTE THE LANGUAGE YOU WOULD LIKE TO RECEIVE INFORMATION ABOUT ACCOUNT: Româna English Русский

I AGREE TO ABIDE BY THE AIR MOLDOVA TERMS AND CONDITIONS

Air Moldova Club Air Moldova Club

To become a member you must be over 12 year old