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Admin
Status
Applicant Details
Given Name(s)*
Surname*
Date of Birth*

DD
MM
YYYY
Passport Number*
Photo Identification
You MUST provide a copy of your photo identification. This can be passport, National ID card or driving licence. If you do not we cannot proceed with arranging your PCR test until you have forwarded this on to us.
Email Address*
Telephone Number*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Proposed Date of Travel*

DD
MM
YYYY
Destination Country*
Time of Departure*

: HH

MM

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Price Breakdown.

Service	Appointment Centre	Test fee	Service Fee - with Mercury Holidays Customer Discount	VAT	Total
PCR Test - 24 hour service	London	£249.00	£0.00	£0.00	£249.00
PCR Test - 24 hour service	Birmingham	£249.00	£0.00	£0.00	£249.00
PCR Test - 48 hour service	London	£165.00	£0.00	£0.00	£165.00
PCR Test - 48 hour service	All other centres	£149.00	£0.00	£0.00	£149.00
Postal PCR Test	---	£120.00	£0.00	£0.00	£120.00

Service Option*
- London Test Centre - 24 hour
- Birmingham Test Centre - 24 hour
- London Test Centre - 48 hour
- All Other Centres - 48 hour
- Postal Test
How would you like to receive your appointment confirmation?*
Total
£ 0.00
Credit Card*

Card Details

Cardholder Name
Billing Address*
Same as home address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Please tick to confirm you you have read, fully understood and agree to the following:*
- I, the applicant, hereby certify that I have read and understood the following
PLEASE NOTE:
- Weekend appointments are only available at Birmingham and London.
- Should the 72 hours prior to your travel date include a Sunday, you MUST opt for the 24 hour service to ensure your results come back in time. The 24 hour services are ONLY available in Birmingham and London.
Please tick to confirm you you have read, fully understood and agree to the following:*
- I, the applicant, hereby certify that I have read, or have had read to me, all the questions and statements on this application and understand all the questions and statements on this application. The answers and information furnished in this application are true and correct to the best of my knowledge and belief.
Terms and Conditions*
- I have read, fully understood and agree to the Terms & Conditions and Client Declaration
http://thetravelvisacompany.co.uk/terms/tvcterms.pdf
http://thetravelvisacompany.co.uk/declaration

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Admin