EB2 National Interest Waiver Program – Preliminary Assessment Form

Date 10 22 2022
MM DD YYYY
First Name, Last Name Date of Birth:
Edd Rumi 07 June 1996
Name as it appears on your passport

Email: rintexjackson27@gmail.com
Contact number: +62 878 1185 9243
Nationality: Indonesia
Country of Birth: Indonesia
Country of residence: Indonesia
If you are married please provide country of birth of your spouse: Indonesia
What are your current number of flight hours? 1200
What are your current number of PIC hours? 70
ATPL date of issue (MM/DD/YYYY): *should exceed 5 years from today’s date N/A
CPL date of issue (MM/DD/YYYY): 08/08/2016
What is your current flight crew rank? First Officer
What was your basic annual salary prior to Covid-19? Rp. 18.000.000
What is your current basic annual salary? Rp. 28.000.000
Please specify the country in which you received this salary: Indonesia
What are your highest educational qualifications? Associate Degree
What 'Type Ratings' do you hold and when do they expire? ATR 72-600 Exp 03/31/2023
Please list all airlines you have experience working for: Garuda Indonesia Airline
Do you have any other aviation qualifications? Yes No
✔ Specify

If yes, please list all

Are you a member of any professional pilot associations? Yes
✔ No professional pilot Asosiasi Pilot Garuda,
associations that
you belong to: under IFALPA
Do you have any experience flying in the Military? Yes No ✔ Specify

Have you received any prizes, awards or other forms of recognition for Yes No ✔ Specify
achievements as a pilot or in the aviation field?

Have you contributed or authored any aviation related articles books Yes
✔ No Specify Garuda Magazine
or professional publications?

Have you been arrested, charged or convicted of an offence? Yes No ✔ If yes, have you been
pardoned?

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