RESERVATION CONFIRMATION FORM
HSE Conference in Maputo 14-17 September 2014
Room reservations & airport transfers should be booked by completing this form and returned by
By Email to: Reservations@serena.co.mz
A confirmation will be sent to all delegates upon receipt of this completed form
Name
Dr. / Mr. / Ms. / Mrs./other:
Select one
Telephone
Last Name
(
)
Country code/ Area code/ Telephone
No.
First Name
Facsimile
(
)
Country code/ Area code/ Facsimile No.
Arrival
Departure
Date/Time
Date/Time
Pre-booking requirement: [please specify date you require a room]:
Arrival Flight
Departure Flight No
No
Transportation Request:
From Mavalane International Airport
From Hotel to Mavalane International Airport
(date :
(date :
)
)
Credit Card Details
To guarantee your booking, kindly provide us your credit card details.
.  American
Express
. 
Diners Club .  Master
Card
. 
VISA
Cash
. X 
Others:
Credit Card Number:
Card Member’s Name:
Expiry Date:
CVC Number:
Signature:
Alternatively money can be transferred to the hotel using the details below:
A/C:
Account Name: Hoteis Polana Sarl
Date:
please confirm with reservations
Bank Name: Banco Standard Bank Moçambique [Account No. 108 464998 101 1 USD]
SWIFT CODE: SBICMZMX
IBAN MZ59000301080464998101142
Maputo Mocambique7328681
Rooms Run of the House: Polana Mar & Main Hotel
Group Rate
[Studio Room City View] US$300.00
(Single only)
[Standard Room Sea View]
US$300.00 (Single)
US$383.00 (Double)
[Deluxe Room City View] US$300.00
(single)
US$383.00 (Double)
Polana Mar & Main Hotel
[Deluxe Room Sea View] US$300.00
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(single)
US$383.00 (Double)
[Executive Suite Sea Facing]
US$722.00 (Single)
US$805.00 (Double)
 Above mentioned rates includes Breakfast & all government taxes.
Special Requests (Please tick) * All requests are subject to availability.
.
 King Bed
.
 Twin Bed .
 Smoking room .
 Non-smoking room
 All reservations are subject to confirmation by the Hotel. Kindly return your completed booking form
by 15th August 2014.
 The official check-in time is1400hours and the check-out time is 1100 hours.
 In the event of a no-show, a one-night room charge will apply and the charge will be debited to your
credit card. Terms and conditions of staying at the Hotel apply.
HOTEL USE ONLY
Terms and Conditions

7.1 For rooms cancelled from the group reservation 30 days before the arrival date, no cancellation fee will be charged.

7.2 For rooms cancelled from the group reservation between 7 days and 3 days before the arrival date, one night cancellation fee will
apply.

7.3 For any room/reservation cancelled 3 days prior to the arrival date or any no-shows, the Total Group Accommodation
Revenue will be levied as Cancellation fee, i.e. Total Number of Rooms Booked and Confirmed / No Show x Room Rate x Total
Number of Nights Booked / No Show.
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