Scribd
Upload
381 views1 page

Form 22 The Imigration Act (CHAPTER 133) Immigration Reulations Crew List Regulation31 (1

This document contains a crew list for the supply vessel Sea Dragon 11. It lists the master, two chief officers, and an able-bodied seaman. All crew members are Indonesian citizens with valid passports. The master has signed declaring that the information is accurate and that there are no unauthorized persons on board.

Uploaded by

Gelby Noegraha Sapoetra
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
381 views1 page

Form 22 The Imigration Act (CHAPTER 133) Immigration Reulations Crew List Regulation31 (1

This document contains a crew list for the supply vessel Sea Dragon 11. It lists the master, two chief officers, and an able-bodied seaman. All crew members are Indonesian citizens with valid passports. The master has signed declaring that the information is accurate and that there are no unauthorized persons on board.

Uploaded by

Gelby Noegraha Sapoetra
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Callsign : JVHT6 FORM 22 GDV No:

Type : Supply Vessel THE IMIGRATION ACT PCC No :


Grt : 78 ( CHAPTER 133)
Flag : Ulan Batar IMMIGRATION REULATIONS
CREW LIST
REGULATION31 (1)

Name of Ship : SEA DRAGON 11 Owners or Charterer : SEA- DRAGON MARINE


SERVICES PTE LTD
Agent : SEA-DRAGON MARINE
SERVICE PTE LTD
Date or Arrival :
Last Place Of Embarkation : OPL
Next Destination : OPL
Date of Proposed Departure :
NO NAME SEX DATE OF NATIONALITY PASSPORT EXPIRE DUTIES
BIRTH NUMBER DATE
1 HASRIP M 10.01.64 INDONESIA C1909397 13.02.24 MASTER
KILIT 17/07/2018
2 DADANG M 20.12.87 INDONESIA B2994445 27.01.21 C/OFF
ARIFIN 01/06/2019
3 INDRA M 04.01.67 INDONESIA C0318599 03.07.23 C/ENG
BHAKTI 03/09/2018
4 AGUNG M 09.04.73 INDONESIA C0844972 09.07.23 AB
SRIYONO 17/07/2108

Master do hereby declare that the above information is to the be the best of my knowledge and belief,
true in every perticular and there are no stowaways or unauthorized persons onboard my vessel.

...........................................
Master/ Owner /Agent

You might also like