Holland America Immigration Form
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1Holland America Immigration Form
PASSENGER #1
Name:
Date of Birth:
/
/
Gender: MALE / FEMALE
Citizenship:
Country of Residence:
Passport #
Issue Date
/
/
Expiration Date
/
/
Country of Passport Issuance
Country of Birth
Are you planning on using a Birth Certificate or other Western hemisphere Travel Initiative-compliant document instead of Passport? Y/N
HOME ADDRESS:
Address
City
State
Zip Code:
Telephone #:
EMERGENCY CONTACT INFORMATION
Contact Name
Relationship
Telephone
Address
City
State
Zip Code
PASSENGER #2
Name:
Date of Birth:
/
/
Gender: MALE / FEMALE
Citizenship:
Country of Residence:
Passport #
Issue Date
/
/
Expiration Date
/
/
Country of Passport Issuance
Country of Birth
Are you planning on using a Birth Certificate or other Western hemisphere Travel Initiative-compliant document instead of Passport? Y/N
HOME ADDRESS: Same as above:
Address Line 1
City
State
Zip Code:
Telephone #:
EMERGENCY CONTACT INFORMATION: Same as above:
Contact Name
Relationship
Telephone
Address
City
State
Zip Code
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Parent category: Legal