Insurance and Financial Practitioners Association of Singapore

BERJAYA RESORTS - Application Form

Berjaya Resorts Application Form

Personal Details
Salutation :
First Name :	*
Middle Name :	*
Last Name :	*
Gender :
Membership No :
Nationality :
Home Address:	*
Home Contact No :	*
Office Contact No :
Mobile Contact No :	*
Fax No :	*
Email Address :	*
Date of Birth :	*(ddmmyyyy)
Company Name :
Company Address :
BERJAYA HOTELS & RESORTS APPLICATIONS ONLY
Hotel & Resort of Stay :	*
Dates of Vacation :	From To * (ddmmyyyy)
No of Nights :	*
No of 1-Room Required :	*
Full Payment	S$ *
for Berjaya Hotels & Resort Only (inclusive of prevailing GST)
BERJAYA AFFILIATED HOTELS & RESORTS APPLICATIONS ONLY
Affiliated Hotel & Resort of Stay :
Dates of Vacation:	(ddmmyyyy)
No of Nights :
Type of Room Required :
Full Payment for Hotels & Resorts	S$
Hotels & Resorts Affiliated to Berjaya Hotels & Resort Only (inclusive of prevailing GST; per room per night)
Full Payment for Hotels & Resorts	RM
Hotels & Resorts Affiliated to Berjaya Hotels & Resort Only (per room per night)
Payment Method :
Credit Card Type :
Credit Card Number :
Name as on Card :
Expiry Date :	(mmyyyy)
I accept the aforementioned terms and conditions. Please charge te accommodation fee to my account. For bookings of hotels/resorts affiliated with the Berjaya Hotels & Resorts, I agree to allow IFPAS to charge S$60 (excluding prevailing GST) per room per night to my account in addition to surcharges imposed per room per night. The additional surcharges will be charged by Berjaya Hotels & Resorts.
* These are compulsory fields