PLATINUM PERSONAL PROFILE FORM CONTACT INFORMATION

[Pages:4]PLATINUM PERSONAL PROFILE FORM

CONTACT INFORMATION

Platinum Card Number (as it appears on the Card)

3 7 4 4 ?

?

Title

Mr

Mrs

Miss

Ms

Other

First name

Middle name

Surname

HOME ADDRESS

P.O. Box

City

BUSINESS ADDRESS

Country

P.O. Box

City

E-mail

Home Tel. (include area code)

Fax No. (include area code)

Country of birth

Nationality

Passport number*

Name on passport*

Driving licence number*

Driving licence issuing country and/or state

Emergency contact name

Tel. No. (include area code)

Languages spoken:

English

Arabic

Other

How do you prefer to be contacted? Letter

Morning

Afternoon

Number of children:

0

Age of children:

0-5yrs

Do you have a personal assistant/secretary?

Name of assistant

Tel. No. (include area code)

E-mail

Country

Business Tel. (include area code) Mobile Tel. (include area code)

Date of birth Passport valid until

D DM M Y Y D DM M Y Y

*To be used for visas and car rental

E-mail Evening

1 5-10yrs

Yes

Telephone Home 2

10-15yrs No

No preference Office 3

15-21yrs

No preference 4+

Grown up

AUTHORISATION FOR TRAVEL AND LIFESTYLE RESERVATIONS AND BOOKINGS

I hereby authorise the Platinum Travel and Lifestyle Team to charge any Travel or Lifestyle reservations and bookings, by verbal (via phone) or written consent, via myself or another person(s) authorised by me, from the date below, subject to the expiration of my American Express? Cardmembership or until my written notice of cancellation of said authorisation.

Platinum Cardmember Signature X

Date

I authorise person(s) below to carry out instructions on my behalf to the Platinum Travel or Lifestyle Team, for which my Card Account will be charged.

Please enclose a copy of all authorised person(s), passport(s), (including resident's permit if an expatriate), and social security/CPR/Tabia/ work permit/driving license/I.D. No./Civil I.D.

First authorised person

Function

E-mail

Signature X

Date

Second authorised person

Function

E-mail

Signature X

Date

LIFESTYLE (PLEASE TICK)

What are your main interests/hobbies? Golf

Tennis

Football

Rugby

Skiing

Horse racing

Motor sports

Sailing

Diving

Riding

Walking/Climbing

Other(s)

Theatre

Opera

Music concerts

Art Exhibitions

Food

Fashion

Antiques

Other(s)

TRAVEL (PLEASE TICK)

GENERAL

How frequently do you travel on business?

Weekly

Monthly

Every 3 months

Occasionally

How frequently do you travel for leisure?

Monthly

Every 3 months

Every 6 months

Once a year

Which cities do you travel to most often?

For business: 1

2

For leisure: 1

2

When you are travelling which areas would you most like assistance with booking?

Hotels

Restaurants

Tickets (Theatre, Opera, Concerts, Sporting)

Golf

Private Clubs

Other(s)

Which holidays are you most interested in?

Luxury hotels

Spa hotels

Weekend breaks

Private yachts

Skiing

Cruises

Private villas

Private islands

Caribbean

Far East

Americas

Africa

Europe

Middle East

Other(s)

Who do you normally book your travel through?

AIRLINE PREFERENCES

Preferred airline and details of any frequent traveller programmes:

1st choice airline

Frequent flyer number

2nd choice airline

Frequent flyer number

3rd choice airline

Frequent flyer number

Service class preferences:

Middle East flights:

First Class

Business Class

Economy Class

International flights:

First Class

Business Class

Economy Class

Your seating preferences:

No preference

Aisle

Window

Other(s)

Your meal preferences:

No preference

Vegetarian

Vegan

Other(s)

HOTEL PREFERENCE

Preferred hotel chain and details of any hotel loyalty memberships:

1st choice hotel chain

Loyalty card number

2nd choice hotel chain

Loyalty card number

Special room requests:

Smoking Non-Smoking

Other(s)

CAR HIRE PREFERENCES

Preferred car hire company and details of any loyalty memberships:

1st choice car hire company

Loyalty card number

2nd choice car hire company

Loyalty card number

Preferred car:

Small/Economy

Midsize

Estate

Luxury

Other (s)

Emergency Exit Low Cholestrol

Manual

Automatic

Platinum Cardmember Signature X

Date

4x4/SUV

Platinum Services. AMEX (Middle East) B.S.C. (c), P.O. Box 2641, Manama, Kingdom of Bahrain. .bh/platinum

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