MDAC TRAVEL CONSULT SERVICES

Surname *

Enter your Surname exactly as shown in your passport

First/Given Names *

Enter your First/Given Name(s) exactly as shown in your passport

Date of Birth *

Residence *

Country of Birth *

nationality *

Gender *

Male Female

Provide details of the passport that you will use to enter the United States of America. Enter these details exactly as they appear in your passport.

Country of Passport *

Hong Kong or Macau passport holders are not eligible.

Passport Number *

Enter the Passport Number as it appears on the Passport you are traveling with.

Passport Date of Issue *

Passport Expiry Date *

Email Address *

Confirm Email Address *

Mobile/Cell Telephone *

Please select your country code and write your phone number without the country code

Your date of entry into Singapore *

The date of your departure from Singapore *

Which city are you traveling from to Singapore (required) *

The city you will be going to after leaving Singapore (required) *