Become an Agent

Agent Registration Form

This is a multi-part agent registration form.
On this page you need to enter your personal information.
Ensure that you have completed all your information correctly then click next to proceed to the next part of the form.

Full Name(*)

Please type your full name.

E-mail(*)

Invalid email address.

Mobile(*)

Invalid mobile Please use this format: +27 82 555 1234

Landline

enter landline phone number.

On this page you need to indicate if you are registering in your personal capacity or as a authorised representative of a business or organisation.
Ensure that you have completed all your information correctly then click next to proceed to the next part of the form.

Capacity(*)

Please select in which capacity you are contacting us in.

Please tell us a little about the company/organisation you are inquiring on behalf of.

Company/Organisation

Please type your company or organisation name

Position(*)

please select your position

Enter Position(*)

please enter your position at the company/organisation

Are you authorised to represent your company/organisation(*)

Yes . . .No please let us know whether you are authorised to order on behalf of your company/organisation

On this page you need to provide us with an official address where documents can be delivered.
Ensure that you have completed all your information correctly then click next to proceed to the next part of the form.

Address line1(*)

please enter address line 1

Address line2

Invalid Input

Suburb

Invalid Input

City(*)

Invalid Input

Province / State / Territory etc.

Please enter your Provence or State

Area Code

Invalid Input

Country(*)

Please enter your country of operations!

Your time-zone(*)

Please select your time-zone

Please supply us with your banking information where we can deposit your commission payments

Ensure that you have completed all your information correctly then click next to proceed to the next part of the form.

Name of account holder(*)

please insert bank account holder name!

Bank Account Number(*)

Please insert your bank account number

IBAN code

Invalid Input

Swift Code

Invalid Input

Bank Name(*)

please provide you bank's name!

Branch Code

Please enter branch code!

Country where bank is(*)

please select where your bank is!

Extra info

Invalid Input

Please let us know if there is any additional banking information

PLEASE NOTE: KAIA TRAVEL respects your privacy. Your banking details will only be used for making payments to you with regard to KAIA TRAVEL related product commissions and will not be shared with any other non KAIA TRAVEL related entities or organisations.

Please let us know how and when to contact you.

How should we contact you?

E-mailMobileLandlineNewsletter

When is it convenient for us to contact you?(*)

Mornings

Lunchtime

Afternoons

After Work

Please select at least one convenient contact time!

Anti SPAM Check
please tick square(*)

please tick to prove that you are human!

Please ensure that you have made all the correct selections and have supplied all the relevant information to us, then click on the blue SUBMIT button.