ASCENSION ISLAND GOVERNMENT
Flight Bookings
Ascension Island Government
Administration Building
Georgetown, Ascension IslandTel: (+247) 66700 ext 111
flight.bookings@ascension.gov.ac

Flight Booking Form (page 1 of 2)
BEFORE we can process your flight booking request ALL sections of this form must be FULLY completed in
CAPITAL letters.

Name:(Supplied as a reference for your booking. Other relevant information may be added below)

Correspondence Address:

Country:
Email address:
Date of Flight: Brize Norton UK (BZZ) to Ascension Island (ASI)
Date of Flight: Ascension (ASI) to Brize Norton UK (BZZ)
No. of Adults:

No. of Children:

State if you are a resident of Ascension Island,Falkland Islands, St. Helena Island, UK or Other:

Nationality

Passport Issuing State

Track & Trace Contact Number

Names of passengers on this flight/booking
Title(Mr/Mrs/Ms/Miss/Mstr)

Forename

Surname

Date of birth

Passport No.

DD/MM/YYYY

Passport Expiry
Date
DD/MM/YYYY

Sponsorship Details
Next of Kin

Name

Relationship

Relationship

Full Address & Tel No.

Contact Details
Intended Address on Island

Additional Information Please indicate your answers to the below questions by CIRCLING either YES or NO. For questions answered YES,
supporting details must be provided on page 2 of this form. Support details must be clear and concise, and should
include full name of your medical or mobility condition and the name of any medication. All information will be kept
confidential,
1/ Have you had any recent illness/injury requiring medical treatment?
2/ Do you require assistance boarding & disembarking the aircraft?
3/ Are you pregnant? If yes, please advise estimated date of delivery
4/ Do you require a sky cot?
5/ Do you have any special dietary requirements?
Vegetarian □ Diabetic □ Known allergies □6/ Do you have any medical or mobility problems?

YES/NO
YES/NO
YES/NO
YES/NO
YES/NO
YES/NOASCENSION ISLAND GOVERNMENT
Flight Booking Form (page 2 of 2)
Payment Method: (please tick) Ascension Island Government
Bank Transfer□ Credit/Debit Card □Payment must accompany this form if made within 4 weeks of flight time.

You may add your credit/debit card details to this form should you wish:
Credit/Debit Card details: n.b. we will not process your credit card until near the time of departure so please ensure thatyour credit card will not have expired by then.

Name on Card:
Card Type: (Visa, Mastercard etc.)

Card Number: (e.g. 4676 0000 0000 0000)(We do not accept American Express cards.)

Expiration Date:

Valid From: (if available)

MM/YYYY
Issue No.

CVV Security Code:(if applicable)

Last three digits printed on the signature strip

MM/YYYY

3 Digits

Card Holder Address: (Statement address)

Additional Information supporting details

1/
2/
3/
4/
5/
Notice regarding all flight bookings:
Please note that the MOD reserves the right to change fares/dates of travel without notice. Even after payment has been
received, fare increases by the MOD might affect the final price you pay for your flight. If the MOD increases the fare
before the date of either your outward or return travel you may be required to make an additional payment.
Notice regarding bookings for all provisional flight dates*:
AITA can accept on a first come first serve basis bookings for provisional flight dates. All provisional flight dates are
made on the assumption that when the MOD releases a new flight schedule the dates will remain the same.
However, in doing so AIG will not be held responsible for any changes the MOD may make when a new schedule ispublished. Customers must understand that they make all bookings for provisional dates at their own risk. AIG will not
accept any liability for bookings made under these circumstances, in particular if the provisional dates are changed once
the MOD publishes the new schedule.
If there are any changes to provisional dates when the MOD publishes the new flight schedule, AIG will contact thosepersons affected to try place alternative bookings.
* Provisional flight dates: All provisional flight dates are highlighted in the Flight Schedule.
I solemnly declare that I have answered the foregoing questions and completed this form fully and accurately, and I haveread the above notice and agree to abide by it.
Name:

Signature:_____________________________________________________________________________
Date Received: ______________________FOR OFFICIAL USE
Authorised for Booking: ___________________________
Travel Assistant