FORM 25

IMMIGRATION ACT Regulation 31(1)

(CHAPTER 133)

11-OCT-22
IMMIGRATION REGULATIONS
PASSENGER LIST (DISEMBARKATION AT SINGAPORE)

(Note: This form shall include all passengers who are finally disembarking in Singapore.)

*Name/Identification No. of *Vessel/Train HUGO AND *Master/Owner/Charterer OWNER

GIORGIO
Agents in Singapore HANS YACHT SERVICES PTE.
LTD.
Last place of embarkation INDONESIA - Date of Arrival 11/10/2022
NONGSAPURA
Next destination INDONESIA - NONGSAPURA Date of proposed departure 11/10/2022

Travel Document Expiry Date

Nationality/
No. Name Sex Date of Birth of Travel
Citizenship No. Documents
1 BENNY SUGIYONO M 13/08/1992 IDN X1081154 14/03/2027
2 LEOW YONG QING M 10/03/2001 SGP K3076931H 19/07/2032
3 LILIARTI F 24/05/1967 IDN X805696 13/06/2024
4 SUGIYONO LIM M 21/12/1965 IDN X805579 10/06/2024

I certify that the above information is, to the best of my knowledge and belief, true in every particular
Dated this day of 20

___________________________
*Master/Owner/Charterer/Agent

* Delete whichever is inapplicable

Note: If the spaces provided are insufficient, use an additional sheet drawn in the same format and with the
heading '"Form 25 - Continued".

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