FP1802 Crew Data Form
Hire Date July 18 2022 MAPS ID
(month) (day) (year)
NAME Ade Sadwika I Komang Dept Bar
(last) (first) Position Bar Utility
Onboard/Ship
Address Br.Dinas Pajahan, Pajahan, Pupuan
Home Airport Denpasar – Indonesia : DPS
City Tabanan Postal Code 82163 Marital Status X
Country Indonesia Single Married Divorced Widowed Separated
Phone # +62 81339804501 Sex X
(country code), (city code), # Male Female
Email Adesadwika420@gmail.com Personal Attributes Black Brown 171cm 65kg
(hair) (eyes) (height) (weight)
SS# (US Only) Date of Birth July 14 1988
(month) (day) (year)
ARC # Birthplace Tabanan, Bali
Citizenship / Country Indonesia
Passport # C9825625 Passport Issue Date Sep 02 2022
(month) (day) (year)
Passport Country / City of Issue Indonesia/Singaraja Passport Expiry Date Sep 02 2027
(month) (day) (year)
Second Passport # 2nd Passport Issue Date
(month) (day) (year)
2nd Passport Country / City of Issue 2nd Passport Expiry Date
(month) (day) (year)
Seaman’s Book # H062381 Seaman’s Book Issue Date Aug 26 2022
(month) (day) (year)
Seaman’s Book Country of Issue Pelabuhan Kelas II Benoa Seaman’s Book Expiry Date Aug 26 2025
(month) (day) (year)
C1D Visa # C1D Visa Expiry Date
(month) (day) (year)
Date of last Physical Exam
(month) (day) (year)
Languages (Other than English) -
Emergency Contact Dependent Information
Name Komang Weny Wulandari Name Date of Birth
I Komang Ade Sadwika July 14,1988
Relationship Wife
Address Br.Dinas Pajahan, Pajahan, Pupuan
City/State Tabanan
Country Indonesia
Phone # 082237650313
Mobile #
Sign off Date
(month) (day) (year) Signature I Komang Ade Sadwika
