By completing and submitting this form you are indicating that you want your details registered for the purposes of repatriation from Fiji back to Vanuatu.

Part A - Personal Details (Only one (1) person to complete the form, if you have dependents add them in Part C)

First Name 
Last Name 
Age 
Gender
Telephone No.
Email Address

Part B - Occupation/Nationality/Medical Details

Nationality
Passport No. 
Resident Permit No. (If not citizen)
Status
Location 
Medical Conditions

Part C - Dependents

  Full Name Age Citizen/Resident Passport No.
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2
3
4
5
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