Request for PRM assistance

This request is valid only if you have notified your airline/ travel agent of your need of assistance.

Applicant's data

Name of applicant: *

Phone number of applicant: *

Address of applicant: *

City: *

E-mail address: *

Is the applicant the same person as the passenger?: * - Select -YesNo

Passenger's data

Name: *

Surname: *

Gender: *

Male

Female

Age: *

Mobile phone number:

Able to walk?: *

Yes

No

Able to use the staircase?: *

Yes

No

If you can not walk, do you own a wheelchair?:

Yes

No

Electrical wheelchair?:

Yes

No

Wet cell?:

Yes

No

Do you travel with oxygen?: *

Yes

No

Other physical restrictions?:

Arrival date: *

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MonthJanFebMarAprMayJunJulAugSepOctNovDec

Year20192020

Arrival date at Sofia Airpor

Arrival time: *

hour01234567891011121314151617181920212223

:

minute00153045

Arrival time at Sofia Airport.

Flight date: *

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MonthJanFebMarAprMayJunJulAugSepOctNovDec

Year20192020

Flight number: *

Other remarks:

What code is in the image?: *

Enter the characters shown in the image.