Advance Information Form

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S/N FULL NAME PARENTAGE DATE & PLACE OF BIRTH NATIONALITY OCCUPATION PRESENT ADDRESS PERMANENT ADDRESS 1 KAZUHIRO ARAI UMEKICHI ARAI JAPAN ENGINEER NO 2 LABORIE FRANCAISE NO 3 WAHYUDI SETIYAWAN SETIYAWAN INDONESIA NO 4 PACKIRISAMY BASKAR V PACKIRISAMY INDIAN N/A NO 5 BULIK ANAK GRINANG GRINANG MALAYSIA CTO NO 6 MEDCALF NO PASSPORT DETAILS ( NO/Issued at/Valid upto) VISA DETAILS(No/Typ e of Visa/Validity) PLACE & PURPOSE OF VISIT DETAILS OF LAST VISIT TO INDIA 24 MAY 1952 KANAGAWA JAPAN M/S. SWIBER OFFSHORE INDIA (PVT.) LTD. 502-B WING, DELPHI, HIRANANDANI GARDENS, POWAI, MUMBAI -76. 8-16 SETO, KANAZAWA-KU, YOKOHAMA KANAGAWA- KEN 236-0431 JAPAN TK4191589 MINISTRY OF FOREIGN AFFAIRS JAPAN 04 APR 2011 04 APR 2021 UNDER PROCESS OFFSHORE FIELD TO JOIN SWIBER VESSEL /BARGE LABORIE PATRICK, MICHEL 09 AUG 1974 LAGNY SUR MARNE FRANCE MAINTENANCE SUPERVISOR M/S. SWIBER OFFSHORE INDIA (PVT.) LTD. 502-B WING, DELPHI, HIRANANDANI GARDENS, POWAI, MUMBAI -76. PRIMA REGENCY, PLENTONG 5 K20 BERMERICOURT FRANCE 12CV05846 KUALA LUMPUR - AMBASSADE DE FRANCE EN MALAISIE 17 AUG 2012 29 JUN 2019 UNDER PROCESS SATELLITE FIELD (B&S) TO JOIN SWIBER VESSELS/ BARGES 19 FEB 1984 BANYUWANGI INDONESIA MD TECHNICIAN M/S. SWIBER OFFSHORE INDIA (PVT.) LTD. 502-B WING, DELPHI, HIRANANDANI GARDENS, POWAI, MUMBAI -76. TAMAN VALENCIA BLOK A NO. 28 BATAM INDONESIA S 425446 BATAM INDONESIA 13 OCT 2008 13 OCT 2013 UNDER PROCESS OFFSHORE FIELD TO JOIN SWIBER VESSEL /BARGE 11 MAY 1972 PONMALAI TN INDIA OPERATIONS MANAGER APT BLK 469 CHOA CHU KANG AVENUE 3#05-97 SINGAPORE 680469 NO 14 7TH CROSS GANDHI SALAI KAILASH NAGAR KATTUR POST TRICHY TAMILNADU 620019 INDIA Z1826126 SINGAPORE 20 FEB 2009 19 FEB 2019 OFFSHORE FIELD TO JOIN SWIBER VESSEL /BARGE 12 JUL 1977 SARAWAK MALAYSIA M/S. SWIBER OFFSHORE INDIA (PVT.) LTD. 502-B WING, DELPHI, HIRANANDANI GARDENS, POWAI, MUMBAI -76. P.O BOX 4281, RUMAH ACHAN, SUNGAI AMANG, 96800 KAPIT SARAWAK, MALAYSIA K24323766 SIBU MALAYSIA 14 JUN 2011 14 DEC 2016 UNDER PROCESS OFFSHORE FIELD TO JOIN SWIBER VESSEL /BARGE MEDCALF DAVID MICHAEL 31 MAY 1947 GUILDFORD UK BRITISH CITIZEN SENIOR DIVE TECHNICIAN M/S. SWIBER OFFSHORE INDIA (PVT.) LTD. 502-B WING, DELPHI, HIRANANDANI GARDENS, POWAI, MUMBAI -76. DULVERTUN, HOLLY CLOSE, HEADLEY DOWN, BORDON, LUANTS GU35 8JN, SOMERSET, SOUTH WEST ENGLAND, UK. 511044611 IPS UK 01 OCT 2012 01 APR 2023 UNDER PROCESS OFFSHORE FIELD TO JOIN SWIBER VESSEL /BARGE

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Transcript of Advance Information Form

Page 1: Advance Information Form

S/N FULL NAME PARENTAGE NATIONALITY OCCUPATION PRESENT ADDRESS PERMANENT ADDRESS

1 KAZUHIRO ARAI UMEKICHI ARAI JAPAN ENGINEER NO NO NO

2 LABORIE FRANCAISE NO NO NO

3 WAHYUDI SETIYAWAN SETIYAWAN INDONESIA MD TECHNICIAN NO NO NO

4 PACKIRISAMY BASKAR V PACKIRISAMY INDIAN N/A NO NO NO

5 BULIK ANAK GRINANG GRINANG MALAYSIA CTO NO NO NO

6 MEDCALF BRITISH CITIZEN NO NO NO

DATE & PLACE OF BIRTH

PASSPORT DETAILS ( NO/Issued at/Valid

upto)

VISA DETAILS(No/Ty

pe of Visa/Validity)

PLACE & PURPOSE OF VISIT

DETAILS OF LAST VISIT TO

INDIA

DETAILS LAST VISIT

OF RESTRICTE

D AREAS IN INDIA

WHETHER PERMISSIO

N REJECTED EARLIER,

IF SO, DETAILS THEREOF

24 MAY 1952KANAGAWA

JAPAN

M/S. SWIBER OFFSHORE INDIA (PVT.) LTD.

502-B WING, DELPHI, HIRANANDANI GARDENS,

POWAI, MUMBAI -76.

8-16 SETO, KANAZAWA-KU, YOKOHAMA

KANAGAWA-KEN 236-0431 JAPAN

TK4191589MINISTRY OF

FOREIGN AFFAIRSJAPAN

04 APR 201104 APR 2021

UNDER PROCESS

MUMBAI HIGH OFFSHORE FIELD TO JOIN SWIBER

VESSEL /BARGE

LABORIE PATRICK, MICHEL

09 AUG 1974LAGNY SUR MARNE

FRANCEMAINTENANCE

SUPERVISOR

M/S. SWIBER OFFSHORE INDIA (PVT.) LTD.

502-B WING, DELPHI, HIRANANDANI GARDENS,

POWAI, MUMBAI -76.

PRIMA REGENCY, PLENTONG 5 K20

BERMERICOURT FRANCE

12CV05846KUALA LUMPUR - AMBASSADE DE

FRANCE EN MALAISIE17 AUG 201229 JUN 2019

UNDER PROCESS

BASSIEN FIELDS / BASSIEN &

SATELLITE FIELD (B&S)

TO JOIN SWIBER VESSELS/ BARGES

19 FEB 1984BANYUWANGI

INDONESIA

M/S. SWIBER OFFSHORE INDIA (PVT.) LTD.

502-B WING, DELPHI, HIRANANDANI GARDENS,

POWAI, MUMBAI -76.

TAMAN VALENCIA BLOK A NO. 28 BATAM

INDONESIA

S 425446BATAM

INDONESIA13 OCT 200813 OCT 2013

UNDER PROCESS

MUMBAI HIGH OFFSHORE FIELD TO JOIN SWIBER

VESSEL /BARGE

11 MAY 1972PONMALAI TN

INDIAOPERATIONS

MANAGERAPT BLK 469 CHOA CHU KANG AVENUE 3#05-97

SINGAPORE 680469

NO 14 7TH CROSS GANDHI SALAI KAILASH NAGAR KATTUR POST TRICHY TAMILNADU

620019 INDIA

Z1826126SINGAPORE20 FEB 200919 FEB 2019

MUMBAI HIGH OFFSHORE FIELD TO JOIN SWIBER

VESSEL /BARGE

12 JUL 1977SARAWAKMALAYSIA

M/S. SWIBER OFFSHORE INDIA (PVT.) LTD.

502-B WING, DELPHI, HIRANANDANI GARDENS,

POWAI, MUMBAI -76.

P.O BOX 4281, RUMAH ACHAN, SUNGAI AMANG, 96800 KAPIT SARAWAK,

MALAYSIA

K24323766SIBU

MALAYSIA14 JUN 201114 DEC 2016

UNDER PROCESS

MUMBAI HIGH OFFSHORE FIELD TO JOIN SWIBER

VESSEL /BARGE

MEDCALF DAVID MICHAEL

31 MAY 1947GUILDFORD

UKSENIOR DIVE TECHNICIAN

M/S. SWIBER OFFSHORE INDIA (PVT.) LTD.

502-B WING, DELPHI, HIRANANDANI GARDENS,

POWAI, MUMBAI -76.

DULVERTUN, HOLLY CLOSE, HEADLEY DOWN, BORDON, LUANTS GU35 8JN, SOMERSET, SOUTH

WEST ENGLAND, UK.

511044611IPSUK

01 OCT 201201 APR 2023

UNDER PROCESS

MUMBAI HIGH OFFSHORE FIELD TO JOIN SWIBER

VESSEL /BARGE

Page 2: Advance Information Form

S/N FULL NAME PARENTAGE NATIONALITY OCCUPATION PRESENT ADDRESS PERMANENT ADDRESS DATE & PLACE OF

BIRTH

PASSPORT DETAILS ( NO/Issued at/Valid

upto)

VISA DETAILS(No/Ty

pe of Visa/Validity)

PLACE & PURPOSE OF VISIT

DETAILS OF LAST VISIT TO

INDIA

DETAILS LAST VISIT

OF RESTRICTE

D AREAS IN INDIA

WHETHER PERMISSIO

N REJECTED EARLIER,

IF SO, DETAILS THEREOF

7 HERMAWAN INDONESIA NO NO NOOKY KRISNA HERMAWAN

19 OCT 1970UJUNG PANDANG

INDONESIASECOND CAPTAIN

M/S. SWIBER OFFSHORE INDIA (PVT.) LTD.

502-B WING, DELPHI, HIRANANDANI GARDENS,

POWAI, MUMBAI -76.

JL WARAKAS II GG7 NO. 3RTO 13/002, WARAKAS

KAKARTA, UTARA

A 2445140BATAM

INDONESIA10 APR 201210 APR 2017

UNDER PROCESS

MUMBAI HIGH OFFSHORE FIELD TO JOIN SWIBER

VESSEL /BARGE

Page 3: Advance Information Form

ADVANCE INFORMATION LIST OF EXPATRIATES TO BE ENGAGED BY :

M/S. SWIBER OFFSHORE CONSTRUCTION PTE LTD./M/S.PUNJ LLOYD LTED

S/N BLOOD GROUP FATHER'S NAME OCCUPATION

1

2

NAME OF THE APPLICANT (s)

PLACE & DATE OF BIRTH

NATIONALITY(PRESENT / & PAST)

PERMANENT ADDRESS (RESIDENCE)

PRESENT ADDRESS(OFFICIAL)

PASSPORT DETAILS ( NO/Issued at/Valid upto)

VISA DETAILS(No/Ty

pe of Visa/Validity)

PLACE & PURPOSE OF VISIT

DETAILS OF LAST VISIT TO

INDIA

M/S. SWIBER OFFSHORE CONSTRUCTION PTE LTD.

502-B WING, DELPHI, HIRANANDANI GARDENS,

POWAI, MUMBAI -76.

UNDER PROCESS

MUMBAI HIGH OFFSHORE FIELD /TO JOIN SWIBER

VESSELS/ BARGES

M/S. SWIBER OFFSHORE CONSTRUCTION PTE LTD.

502-B WING, DELPHI, HIRANANDANI GARDENS,

POWAI, MUMBAI -76.

UNDER PROCESS

MUMBAI HIGH OFFSHORE FIELD /TO JOIN SWIBER

VESSELS/ BARGES

Page 4: Advance Information Form

ADVANCE INFORMATION LIST OF EXPATRIATES TO BE ENGAGED BY :

M/S. SWIBER OFFSHORE CONSTRUCTION PTE LTD./M/S.PUNJ LLOYD LTED

DIARY NO & DATE OF

FORWARDING DETAILS TO IB

DETAILS OF NO & DATE OF

CLEARANCE RECEIVED FROM IB