Indonesian Visa - Passport Form - Pelagic Surf Charters

Passport / Flight Form

Once your booking is confirmed we will need passport information details for each passenger, this is necessary for our Indonesia Office to arrange your tour permit and transfer you to and from the airport.

"*" indicates required fields

Please fill out the following form below:

Date of your trip*

Name*

First Last

Passport Number*

IMPORTANT NOTE - you will need 1.150.000 Rp (cash) for Mentawai VIsa payable at Padang Airport on arrival.

Nationality*

Mobile*

Alternative Contact Number

Email*

Flight Arrive Padang (Date, Airline, Time)*

Required for transfers to/from to Pelagic

Flight Depart Padang (Date, Airline, Time)*

Sex

Male

Female

Date of Birth

Passport Place of Issue

Passport Date of Issue

Passport Date of Expiration*

Must be valid for a minimum of 6 months to travel to Indonesia

Travel Insurance Company & Policy Number*

Pelagic HIGHLY recommends insurance that includes EVAC - ANY Emergency medical transport costs must be paid by YOU at the time and recovered from your insurance company.

Address

Emergency Contact Name

Emergency Contact Phone Number*

Descriptions

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PASSPORT FLIGHT FORM

Passport / Flight Form

IMPORTANT NOTE - you will need 1.150.000 Rp (cash) for Mentawai VIsa payable at Padang Airport on arrival.

Pelagic HIGHLY recommends insurance that includes EVAC - ANY Emergency medical transport costs must be paid by YOU at the time and recovered from your insurance company.