HIRER DETAILS Email Address * : Full Name * : Address : Contact No : Passport / NIRC No. : International / Local Driving License No. : Country : Date of Birth : Date ==== 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31    Month ===== January Februray March April May June July August September October November December    Year ===== 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 SERVICE REQUIRED Car Hire & Drive : ========================== Proton Wira 1.3 (M) Proton Wira 1.5 (M) Proton Wira 1.5 (A) Proton Wira 1.6 (A) Proton Waja 1.6 (A) Nissan Vannette 7 Seater Proton Perdana V6 2.0(A) Honda VTECH 2.0(A) Toyota Camry 2.2(A) Mitsubishi Pajero (4x4) Limousine Services : ========================== Proton Perdana V6 Mercedes E 220 Mercedes S 320 Mercedes Elegance Mercedes MB1400 7 Seater Toyota 8 Seater Proton Wira Driver Service : ========================== Driver Service Tour Guide Driver

ARRIVAL Pick Up Date Pick Up Time Pick Up Location Flight No. Arrival Time dd/mm/yyyy AM   PM AM   PM DEPARTURE Return Date Return Time Place of Return Flight No. Departure Time dd/mm/yyyy AM   PM AM   PM Others Informations / Requests : PAYMENT Card Type : Select One Amex Diners Master Card Visa Name on Card : Card No. : Expiry Date : Month ===== January Februray March April May June July August September October November December    Year ===== 2004 2005 2006 2007 2008 2009 2010

FAL VACATIONS SDN BHD Wisma FAL, No 68, Jalan 1/76D, Desa Pandan, 55100 Kuala Lumpur. Tel : 603 - 9282 5526 Fax : 603 - 9285 4212 Email: frac@fal.com.my