eTicket Dominican Republic - Application (Departure Only)

Please complete all mandatory fields (marked with red asterisk *)

In this form you will complete application for Departure eTicket only

For Arrival only application form please click here

For Arrival and Departure application form please click here

Departure

Permanent Address:*

Country of Residence:*

City:*

State (ex: New York):*

Postal code or zip code:*

Do you make stops in other countries?*
Yes
No

First Name/s (exactly as they appear on your passport):*

Last Name (exactly as it appear on your passport):*

Date of Birth:*

Year:*

Month:*

Day:*

Gender:*

Place of birth:*

Is the nationality of the passport different from your place of birth?*
Yes
No

Passport Number:*

Civil Status:*

Occupation:*

Email:*

Telephone Number*
(Include + and the country code. Example +17035555678):

Embarkation Port (Departure Airport):*

Disembarkation Port (Arrival Airport):*

Airline Name/Company:*

Flight Date:*

Year:*

Month:*

Day:*

Flight Number:*

Flight Confirmation Number/PNR: (Optional)

Customs Information

DO YOU BRING OR BRING WITH YOU OR IN YOUR LUGGAGE (S), 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)?*

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

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

I confirm that the answers and information in this application are true and correct to the best of my knowledge and belief. I further confirm that I have read and agree with the ''Terms & Conditions" of eticketdominicanrepublicform.com*

Application Form (Departure Only)

Departure

Customs Information