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    Dino Jagiya
    This document is a crew list for the vessel ENA WIZARD containing information such as: 1) The names, dates of birth, nationalities, identification numbers and positions of 18 crew members from Indonesia. 2) The dates of arrival in Singapore, proposed departure to Batam Island, Indonesia and expiration dates of the crew members' travel documents and duties onboard. 3) Certification by the owner of the vessel that the information provided is true to the best of their knowledge.

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    Ad 202202085413 F 1

    Uploaded by

    Dino Jagiya
    37 views2 pages
    This document is a crew list for the vessel ENA WIZARD containing information such as: 1) The names, dates of birth, nationalities, identification numbers and positions of 18 crew members from Indonesia. 2) The dates of arrival in Singapore, proposed departure to Batam Island, Indonesia and expiration dates of the crew members' travel documents and duties onboard. 3) Certification by the owner of the vessel that the information provided is true to the best of their knowledge.

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    Ad 202202085413 f 1

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    This document is a crew list for the vessel ENA WIZARD containing information such as: 1) The names, dates of birth, nationalities, identification numbers and positions of 18 crew members from Indonesia. 2) The dates of arrival in Singapore, proposed departure to Batam Island, Indonesia and expiration dates of the crew members' travel documents and duties onboard. 3) Certification by the owner of the vessel that the information provided is true to the best of their knowledge.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    37 views2 pages

    Ad 202202085413 F 1

    Uploaded by

    Dino Jagiya
    This document is a crew list for the vessel ENA WIZARD containing information such as: 1) The names, dates of birth, nationalities, identification numbers and positions of 18 crew members from Indonesia. 2) The dates of arrival in Singapore, proposed departure to Batam Island, Indonesia and expiration dates of the crew members' travel documents and duties onboard. 3) Certification by the owner of the vessel that the information provided is true to the best of their knowledge.

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    of 2

    FORM 22

    IMMIGRATION ACT Regulation 31(1)

    (CHAPTER 133)

    09-FEB-22
    IMMIGRATION REGULATIONS
    CREW LIST

    *Name/Identification No. of *Vessel/Train ENA WIZARD *Master/Owner/Charterer OWNER


    Agents in Singapore EASTERN NAVIGATION PTE LTD
    Last place of embarkation INDONESIA - BATAM Date of Arrival 22/11/2021
    ISLAND
    Next destination INDONESIA - BATAM ISLAND Date of proposed departure 09/02/2022

    Expiry Date Duties


    Sex Date of Birth Nationality/ Travel
    No. Name of Travel on Board
    Citizenship Document No. Documents
    ADELBERT GIDION
    1 M 22/06/1982 IDN C3512508 22/10/2024 CH OFF
    RUMAIKEWI
    2 PAHARUDDIN M 08/10/1972 IDN C0881612 05/11/2023 A/B
    MASTE
    3 PANSIL LOHONAUMAN M 30/09/1970 IDN B6903984 04/07/2022 R
    MASTE
    4 HERLING KASENDA M 13/07/1960 IDN C7885856 29/07/2026 R
    5 MARKUS MULA M 04/07/1987 IDN C6475510 29/09/2025 OILER
    3RD
    6 PETRUS ARRUAN M 18/07/1983 IDN C6620822 14/07/2025 ENG
    FEBRY PATRISAN SAMSON
    7 M 23/02/1977 IDN X532526 07/03/2023 CH ENG
    TUERAH
    8 ESTEPANUS TUPITU M 13/03/1960 IDN C2877330 17/01/2024 AB 5
    9 ALBERTH YULIANTO PATURU M 05/07/1976 IDN C0189616 20/08/2023 OILER
    2ND
    10 RAINDI TUMBILUNG M 25/03/1987 IDN C6632352 29/01/2026 ENG
    11 EDI SUSANTO M 24/12/1968 IDN C6151441 10/02/2025 AB 3
    12 STEFANUS LAMONGE M 01/09/1987 IDN B8950652 05/02/2023 COOK
    13 YUSRAN HAERUDDIN M 12/06/1985 IDN B7965705 07/09/2022 AB 1
    14 PALDRIN KRES THOMAS M 28/04/1993 IDN C5036963 17/02/2025 AB 2
    3RD
    15 HENDRA SYURIA OGOTAN M 25/09/1983 IDN B7160936 10/05/2022 ENG
    MESSM
    16 NAOFAL PRATAMA M 13/05/1999 IDN C7319470 01/03/2026 AN
    17 ABDUR RAHMAN M 10/12/1973 IDN C7885905 12/08/2026 AB 4
    2ND
    18 ISHAK GUMUNGGILUNG M 09/04/1982 IDN B8215241 12/12/2022 OFF

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

    Page 1 of 2
    ___________________________
    *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 22 - Continued".

    IMM 22 (11/99)

    Page 2 of 2

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