fondo

Pick up Application Form


PERSONAL DETAILS

(*) MANDATORY FIELDS

Last Name(*)
Last name is required.
First Name(*)
First name is required.
Gender(*)
Please choose an option.
DNI/NIE/Passport Number(*)
DNI/Passport Number is required.
Date of birth(*)
Date of birth is required or format is wrong (yyyy-mm-dd).
Mobile phone number(*)
Please fill your mobile phone number.
Telephone(*)
Telephone is required.
Email(*)
Email is required.
Confirm Email(*)
Please confirm your email.
Nacionality(*)
Nacionality is required.
Reason for your stay at the UA
Please enter details of who to contact in the event of an emergency
Name
Telephone Number
Email

PICK UP SERVICE
Date of arrival(*)
Time of arrival(*)
Place of arrival(*)
Flight/Train number(*)
Destination Address(*)
Price

PAYMENT METHOD
  • Account holder: Centro Superior de Idiomas de la Universidad de Alicante, S.A.U.
  • Bank: Banco Santander
  • Branch: Plaza de los Luceros, 1 03001 Alicante
  • Account Number: 0049 6659 03 2816134203
  • Swift Code: BSCHESMMXXX
  • IBAN Code: ES46 0049 6659 0328 1613 4203
  • Please check that the amount transferred, after bank charges have been paid, corresponds to the accommodation fee.
    This application form will not be effective until the proof of payment is attached to this form.
Important:
  • When making the bank transfer or payment, ensure that the following appears: “PICK UP + Surname(s), Name (of student)”
  • Ensure that bank charges are met by the payer.
Attach payment(*) (Max. size 5Mb) (pdf | jpg | jpeg | png)
You must attach your payment proof.
You must accept the conditions of the General Data Protection Regulation.

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