Reservations Form

- Wild Africa Travel Company Booking Number (if known)
- Wild Africa Travel Company Enquiry Reference Number (if known)
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Passenger One
(Primary person responsible for booking)
- Surname*
- Given Names*
- Title*
- DOB*
- Passport Number
- Expiry Date
- Country of Issue
- Any Dietary Requirements*
- Any Medical Conditions*
- Frequent Flyer Numbers
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Passenger Two
- Surname
- Given Names
- Title
- DOB
- Passport Number
- Expiry Date
- Country of Issue
- Any Dietary Requirements
- Any Medical Conditions
- Frequent Flyer Numbers
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Passenger Three
- Surname
- Given Names
- Title
- DOB
- Passport Number
- Expiry Date
- Country of Issue
- Any Dietary Requirements
- Any Medical Conditions
- Frequent Flyer Numbers
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Passenger Four
- Surname
- Given Names
- Title
- DOB
- Passport Number
- Expiry Date
- Country of Issue
- Any Dietary Requirements
- Any Medical Conditions
- Frequent Flyer Numbers
If you have more than 4 passengers, please complete and submit this form then complete a separate from with the additional names and submit.

Travel Insurance
Travel insurance is highly recommended to cover for irrecoverable prepaid travel costs incurred as a result of unforeseen circumstances. For example, if the passenger becomes unexpectedly ill and is unable to travel then the passenger will be able to recover the total costs of their package. Please note every year Wild Africa Travel Company have passengers needing to cancel for many unforeseen reasons. Unfortunately, Wild Africa Travel Company is helpless if passenger has not taken out travel insurance. Cover can be purchased at time of booking. Note: Pre-existing conditions are not automatically covered, please make sure the Travel Insurance Policy wording is read and fully understood.
Please specify below preferred course of action below
I would like to purchase Travel Insurance through Wild Africa Travel Company*
- Yes
- No
1. If you select yes, Wild Africa Travel Company will email you a quote from SureSave Travel Insurance.
2. If you choose to organised your own travel insurance, please send a copy of the Travel Insurance policy to Wild Africa Travel Company.
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Refusal of Recommended Travel Insurance Declaration
- I confirm that I have been offered and chose to decline travel insurance cover through Wild Africa Travel Company
- Signed - (Please print your full name)
- Date

Booking Terms and Conditions Declaration
*
- I hereby declare that I have read, understood and agreed to the Wild Africa Travel Company Terms and Conditions (click to view)
- Signed - (Please print your full name)*
- Date*
By filling in your name above, you are hereby declaring that you have read, understood and agreed to the booking Terms and Conditions.

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