Form 22

IMMIGRATION ACT
(CHAPTER 133)

IMMIGRATION REGULATIO
CREW LIST

Name of Vessel / Nama Kapal :

Gross Tonage / GT Kapal :
Agent in Port / Keagenan :
Owner's / Pemilik :
Date Of Arrival / Tanggal Tiba :
Date Of Departure / Tanggal Berangkat :

No. Name / Nama Awak Sex / Date of Birth / Nationality /

Jenis Kelamin Tanggal Lahir Kebangsaan
1
2
3
4
5
6
7
7
9
10

Total Crews / Total Awak : 10 M Person included master.

Acknowledge
Harbour Master
 Form 22
MMIGRATION ACT
(CHAPTER 133)

ATION REGULATIONS
CREW LIST

Last Port / Pelabuhan Sebelumnya :

Next Port / Pelabuhan Selanjutnya :

Travel Document No. / Doc.Of Travel Expired / Duties on Board /

No. Buku Pelaut Tanggal Berakhir Buku Pelaut Jabatan

7/23/2023

Manager