Forex & Currency

Currency Exchange Form

First Name

Middle Name

Last Name

Date of Birth

Gender

Nationality

Marital Status:

Parents' Details:

Father's First Name

Father's Middle Name

Father's Last Name

Mother's First Name

Mother's Middle Name

Mother's Last Name

Contact & Address:

Email Address

Mobile Number (WhatsApp Preferable)

Phone Number

Current Residential Address

Permanent Address (if different from current):

Identification Details

Passport Number

PAN Card Number

Aadhaar Number

EPIC Number

Purpose of Travel

Country of Travel

Departure Date:

Return Date

Type of Service Required

Currency

Amount (in INR)

Preferred Delivery Method:

Bank Account Details (For Refund/Credit)

Bank Account Number

Account Holder's Name

Bank Name

Branch

IFSC Code

Declaration

I declare that the information provided is true and correct to the best of my knowledge.

I consent to the processing of my personal data for the purpose of this insurance application in accordance with the terms and conditions and privacy policy.

I allowing Bleu Glacio Trip or its staff to contact me and also send their promotional offers.

Forex & Currency

Currency Exchange Form

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