Mauritius All-in-One Travel Digital Form

Traveller
Passenger Type: Non Citizen
Personal Information
Title: mrs Last (Family) Name: First (Given) Name: RIKI Middle Initial:
ARIWIBOWO
Sex: male Date Of Birth: Country Of Birth: Passport Issue Country:
1997-11-16 Indonesia Indonesia
Passport Expiry Date: Passport Number: Proposed Length of Stay Port Of Embarkation:
2027-09-06 D0405520 in Mauritius (days): 2 Indonesia
Nationalities: INDONESIAN Countries visited during last 6 months: Indonesia
Have you experienced any of the following within the past 14 days?
Fever: No Sore Throat: No Joint Pain: No Cough: No
Breathing Difficulties: No Rash: No Loss of Sense of Smell or Taste: No
Possible contact with COVID 19: No
Have you tested positive for Covid-19 in the past 7 days? No
Vaccine
Vaccinated: Yes
First Vaccine: Astra- First Vaccine Date: Second Vaccine: Astra- Second Vaccine Date:
Zeneca : Covishield 2001-08-31 Zeneca : Covishield 2022-02-28
Flight Information
Airline: Saudi Arabian Flight: SV481 Seat: Date Of Arrival:
Airlines 2023-03-22
Purpose of Visit: spouse_of_mauritian Time Of Arrival: 02:20
Contact Info
Email Address: rikiari2021@gmqil.com Mobile Phone: +6289523357158
Fixed Phone:+622189498058 Business Phone:
Permanent Address
Number and Street: Apartment Number: 104 City: Port louis State/Province: Mauritius
Ground floor house.
Marine road port louis
Country: Central African Zip/Postal Code: 11201
Republic
Temporary Address
Hotel Name: VILLAS Number and Street: Apartment Number: 104 Local Phone:
MON PLAISIR ROYAL ROAD POINTE +2302163042
AUX PIMENTS ,
PAMPLEMOUSSES
Quarantine Site: Not Applicable
Contact person in Mauritius
Last (Family) Name: First (Given) Name:
Address: Email: Mobile Phone:
Emergency Contact
Last (Family) Name: First (Given) Name: Address: Kel pasar Country: Indonesia
Mustopa Mustopa muara Tembesi Jambi
indonesia
Mobile Phone: +6289637279939
RIKI's Service Identifier: d4072b05-b35c-449c-97a6-0cb7796f624c