Application – Е-ticket-dominicana

Visitor Selection

One visitor

Group of visitors

Nature of the group*

Number of visitors*

Arrival Information

Embarkation port*

Disembarkation port*

Flight Number*

Flight Confirmation Number*

Other Embarkation port*

Flight Date*

Days of staying*

Please enter a number from 1 to 120.

Travel Purpose*

Airline Name*

Please select*

ARE YOU LODGING IN A PRIVATE RENTAL? (E.G : AIRBNB)

ARE YOU GOING TO STAY AT A HOTEL?

FAMILY/FRIENDS

OWN HOUSE

EMBARKATION (SHIP/FERRY)

TRANSIT

Hotels*

Country of Destination*

Harbours*

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Province*

Municipality*

Street Address*

Departure information

Embarkation port*

Disembarkation port*

Flight Number*

Flight Confirmation Number / PNR*

Other*

Flight Date*

Airline Name*

Main Passenger

Home Address

Street Address*

Country*

City*

First Name*

Last Name*

Date of birth*

Nationality*

Gender*

Passport Number*

Civil Status*

Occupation*

ARE YOU A FOREIGNER RESIDENT IN THE DOMINICAN REPUBLIC?*

RESIDENCE NUMBER*

Passenger 2

First Name*

Last Name*

Date of birth*

Nationality*

Gender*

PASSPORT NUMBER*

Civil Status*

Occupation*

ARE YOU A FOREIGNER RESIDENT IN THE DOMINICAN REPUBLIC?*

RESIDENCE NUMBER*

Passenger 3

First Name*

Last Name*

Date of birth*

Nationality*

Gender*

PASSPORT NUMBER*

Civil Status*

Occupation*

ARE YOU A FOREIGNER RESIDENT IN THE DOMINICAN REPUBLIC?*

RESIDENCE NUMBER*

Passenger 4

First Name*

Date of birth*

Nationality*

Gender*

PASSPORT NUMBER*

Civil Status*

Occupation*

ARE YOU A FOREIGNER RESIDENT IN THE DOMINICAN REPUBLIC?*

RESIDENCE NUMBER*

Passenger 5

First Name*

Last Name*

Date of birth*

Nationality*

Gender*

PASSPORT NUMBER*

Civil Status*

Occupation*

ARE YOU A FOREIGNER RESIDENT IN THE DOMINICAN REPUBLIC?*

RESIDENCE NUMBER*

DO YOU BRING OR BRING WITH YOU OR IN YOUR LUGGAGE (S), YOU AND / OR YOUR FAMILY MEMBERS, CURRENCY VALUES OR ANOTHER PAYMENT INSTRUMENT, AN AMOUNT IN EXCESS OF USD $ 10,000.00 OR ITS EQUIVALENT IN ANOTHER ( S) TYPE (S) OF CURRENCY (S)?*

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Ammount*

Please enter a number less than or equal to 10000.

Currency*

Declare origin of the securities*

Are you the owner of the values you carry ?*

Name*

Sender Name Sender Last Name

Name*

Receiver Name Receiver Last Name

Relationship with sender or receiver*

Use or destiny of the money or values*

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DO YOU BRING WITH YOU OR IN YOUR LUGGAGE LIVE ANIMALS, PLANTS OR FOOD PRODUCTS?*

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DO YOU BRING WITH YOU OR IN YOUR BAGGAGE GOODS SUBJECT TO TAX PAYMENT?*

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Aproximated value*

Currency*

Merchandise description*

Value in dollars*

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NOTE: THE PASSENGER MAY BRING GOODS OR OBJECTS FOR GIFTS FOR A TOTAL VALUE OF UP TO USD $ 500.00 (FIVE HUNDRED DOLLARS). THIS EASE CAN ONLY BE USED AND APPLIED ONCE EVERY (3) MONTHS.

NOTE: THE PRESENTATION OF THIS DECLARATION IS MANDATORY FOR ALL PASSENGERS WHO LEAVE OR ENTER THE DR. FOR MINORS, THIS FORM MUST BE COMPLETED AND SIGNED BY THE RESPONSIBLE ADULT. THE DECLARATION OF INFORMATION FAULTS OR INCOMPLETES MAY ORIGINATE PENALTIES SUCH AS SEIZURES OF SECURITIES, OF GOODS AND DEPRIVATION OF FREEDOM, ACCORDING TO ARTICLE 200 OF LAW 3489, OF CUSTOMS REGIME, AND ARTICLE 4 OF LAW NO. 155-17 AGAINST WASHING ASSETS. THIS DECLARATION MUST BE SIGNED BY THE PASSENGER WHERE IT IS INDICATED

Application Form

Arrival Information

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Departure information

Main Passenger

Home Address

Passenger 2

Passenger 3

Passenger 4

Passenger 5

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helpdesk@e-ticket-dominicana.com

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helpdesk@e-ticket-dominicana.com

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