ele NRTA AES Garuda Indonesia AWARD TICKET FORM / Formulir Award Ticket PLEASE FILL OUT IN CAPITAL LETTERS Jsaah dongan hur besar Member's mame Nema Anggote Mobile Phone Number /Nomor Ponse! AWARO TICKETS Name Nama Salutation/Pangotan : MRMARSIMSINISTR Person 2) Orang 2 TRANSFER AWARO TICKETS Name Namo Salutation! Pango : MRIMRSINSINISTR ai vation Code | Koas Reservasi Tota! ui By signing this form | agree thatthe order wil be processed according tothe GFF Terms and Condtons / Dengan menandstandeni ormulir i, saya menyetuju! parmintean In! dproses sesuat Syart dan Ketentuan GFF foo otficer Petugas™™ jam iD. Number (Namal Ne. ‘toto cial economy clas paid keke Is stl ald and comely unused. Once wave hae commencad on at lest one stcar of the nevairounoe rare>» Garuda Indonesia SURAT KUASA POWER OF ATTORNEY Kami yang bertanda tangan di bawah ini/ We, undersigned below : Nama Lengkap! Full Name No. Kartu Identitas/ ID Card No. Alamat/ Address Memberikan kuasa/ Hereby authorize Nama lengkap/ Full Name No. Kartu Identitas/ ID Card No. Alamat/ Address Untuk proses pengambilan (berikan tanda v pada kotak dibawah ini! For collection proceed (Sign © in the box below) No. Kartu keanggotaan GFF/ EC Plus/ Garuda Indonesia Citi Card (GFF/EC Plus/Garuda Indonesia Citi Card’) No.. D Award ticket, Upgrade Award Surat kuasa ini berlaku khusus untuk proses pengambilan karlu keanggotaan GFF, Award Tiket dan tidak beriaku lagi setelah proses tersebut dilakukan/ This power of attorney shall remain effective until the membership cards or award tickets is received and will thereupon immediate terminate. Tempat Place Tanggal/ Date Pemberi kuasa/ Grantor ‘Yang diberi kuasa/ Attorney-in-fact Materai/Stamp Rp. 6.000, (Nama lengkap/ Full name) (Nama lengkap/ Full name) *) coret yang tidak pet / cross line for unnecessary