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BINTAN LAGOON RESORT

Jalan Indera Segara A.12


Lagoi Bintan Utara
Indonesia 29155
+62 770 691388 (tel
+62 770 691300 (fax)
golfbooking@bintanlagoon.com www.bintanlagoon.com

SIN – BIN : BIN – SIN :


Departure Date : Departure Date :
No Name Gender Date of Birth Passport Number PP Expiry Date Nationality
1 Mrs Camilla Sejr Larsen F 10.01.75 203417087 28.07.18 Danish
2 Mr Morten Kjell Larsen M 25.01.64 204018693 17.07.19 Danish
3 Mr Tore Philip Krogsmyr M 20.10.62 26850137 24.09.18 Norwegian
4 Mr Christian Sorensen M 09.08.76 204107596 03.08.19 Danish
5 Mr Anders Moller Hansen M 24.06.72 203739414 17.03.19 Danish
6 Mr Thomas Schultz M 05.05.63 102594975 24.09.14 Danish
7 Mr Soren Holm Rysgaard M 18.09.67 202935986 03.01.18 Danish
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Name of Staff : _____________________


Date : _____________________

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