Traveller Profile Form

If you have been referred here by American Express, pay.com.au, Point Hacks or McDonalds, you’re in the right place.

Please complete the following form. The more detail you are able to provide at this stage, the better we will be able to serve you.

Your information will not be shared with any unnecessary third party and we take reasonable steps to ensure the security of your data. Please refer to our Privacy Policy for details.

Before you begin

To complete this form you will require passport details of all travellers and details of your rewards accounts including membership numbers and account passwords or PINs.

Traveller Profile Form

1Contact Information

2Passport Details

3Reward Memberships

4Preferences

5Additional Travellers

6Consent

Phone

This field is for validation purposes and should be left unchanged.

Referral

Please tell us how you were you referred here so we can send your completed form to the right agent *(Required)

Personal Information

First Name(Required)

As shown on passport

Surname(Required)

As shown on passport

Referral(Required)

Date of Birth(Required)

Home Address(Required)

City(Required)

State/Province(Required)

Zip/Postal(Required)

Country(Required)

Email(Required)

*please double check for accuracy!

Phone Number(Required)

Business Information

Business Name

ABN

Business Address

City

State/Province

Zip/Postal

Country

Business Email

Your Passport Details

Passport 1

Passport Number (primary)(Required)

Issuing Country(Required)

Nationality (as shown on passport)(Required)

Place of birth(Required)

Issue Date(Required)

Expiry Date(Required)

Upload passport

Max. file size: 50 MB.

Please upload a clear, legible photograph or scan of your passport. Maximum file size is 5MB

Do you have more than one passport?

Yes

Additional Passport Details

Passport 2

Passport Number (primary)

Issuing Country

Nationality (as shown on passport)

Place of birth

Issue Date

Expiry Date

Upload passport

Max. file size: 50 MB.

Please upload a clear, legible photograph or scan of your passport. Maximum file size is 5MB

Airline Membership Programs

Please enter full details of all reward programs you are a member of.

Frequent Flyer Membership 2

Frequent flyer program name

Membership Number

Password or PIN

(optional)

Any other relevant details

(if applicable)

Frequent Flyer Membership 2

Frequent flyer program name

Membership Number

Password or PIN

(optional)

Any other relevant details

(if applicable)

Other Reward Memberships

Please enter the details of any other travel and reward points memberships you hold including airline, hotel, cruise line and car hire.

American Express Rewards

This field is hidden when viewing the form

I have Amex Reward Points to apply to my booking(Required)

Yes

Unsure

I have Amex Reward Points to apply to my booking

Type of American Express Card (please select)

Number of Amex Reward Points available for use

optional

Travel Preferences

Please enter the details of your specific travel preferences

Additional Travellers

Traveller 2

Traveller 2 Name (as per passport)

Date of birth

Passport Number

Country of issue

Expiry date

Traveller 3

Traveller 3 Name (as per passport)

Date of birth

Passport Number

Country of issue

Expiry date

Traveller 4

Traveller 4 Name (as per passport)

Date of birth

Passport Number

Country of issue

Expiry date

Traveller 5

Traveller 5 Name (as per passport)

Date of birth

Passport Number

Country of issue

Expiry date

The Well Connected Traveller Privacy & Disclosure Notice

The Well Connected Traveller (TWCT) collects information about you to provide products and services to you, process your travel arrangements, facilitate your participation in the loyalty programs of airlines, conduct marketing activities and market research. If the information is not provided, TWCT may not be able to provide the service requested. TWCT may disclose your personal information to its related companies, Travel Service Providers, organisations which provide services to TWCT and your employer if you are travelling on a ticket provided through your employer’s corporate travel arrangements. TWCT and suppliers may also disclose your personal information to various law enforcement agencies and governments around the world for security, customs and immigration purposes. In certain circumstances, we may collect sensitive information about you such as financial information, ethnic origin, religious beliefs or health information. We will only collect sensitive information with your consent and where it is reasonably necessary or directly related to the provision of our services. TWCT’s Privacy Statement can be viewed in full at www. thewellconnectedtraveller.com.au. If you would like access to your personal information or like to have your personal information corrected, you can do so by contacting TWCT at

Acknowledgement and consent(Required)

I have read and understood the Privacy and Disclosure Notice. I consent to the collection and use of all personal information I have provided in this form for the purposes and uses set out above. I acknowledge that all information I have provided is true and accurate and I consent to receiving communications from The Well Connected Traveller from time to time.