Thank you for using the SG Arrival Card!

This SG Arrival Card is only valid for one time use for travel on the
expected date of arrival indicated below. You may choose to download or print a copy of this acknowledgement
and retain it for the duration of your stay.Please note that the SG Arrival Card is not a visa. The use of the SG
Arrival Card e-Service is free of charge.

The unauthorised consumption, possession, import, export and/or trafficking of any controlled drug is an offence
under Singapore's Misuse of Drugs Act. Under the Act, drug trafficking is punishable by death.

Providing false health and travel declarations is an offence under Section 64(b) of Singapore's Infectious Diseases
Act. The penalty for providing false or misleading information is a fine of up to S$10,000 and/or imprisonment of
up to 6 months. For subsequent offence(s), the penalty is a fine up to S$20,000 and/or imprisonment of up to 12
months.You are reminded that it is your responsibility to update and resubmit your declarations prior to your
arrival in Singapore if you had contact with a COVID-19 case, and/or if there is any change in your health status
and/or travel history.

You are required by law to give a report using Form NP 727/A/B/C if the total value of currency and/or bearer
negotiable instruments you are carrying exceeds SGD 20,000 (or equivalent in a foreign currency).

If you are bringing in any item, or carrying an item for someone else, but you do not know what it contains, you
must declare the item at the Red Channel.

You can refer to the ICA website at Entering and Departing Singapore(https://www.ica.gov.sg/enter-depart) for
more information on Singapore's entry requirements and the list of prohibited or controlled items.

Transaction Date: 19/01/2023 04:00 PM (Singapore Time)

Number of travellers: 10

Lead Traveller JAWARA ANDRA PATRA

DE Number Full Name (In Passport) Passport Number

Z9599R5710 JAWARA ANDRA PATRA X1893520

Traveller 2 YENI PURTIKA SIMANJUNTAK

DE Number Full Name (In Passport) Passport Number

Z9599R5813 YENI PURTIKA C9416823
SIMANJUNTAK
Traveller 3 JUNAIDI

DE Number Full Name (In Passport) Passport Number

Z9599R5911 JUNAIDI X1736265

Traveller 4 YUMIANTI

DE Number Full Name (In Passport) Passport Number

Z9599R6018 YUMIANTI X1736263

Traveller 5 TARISA PUTRI ARTHA

DE Number Full Name (In Passport) Passport Number

Z9599R6115 TARISA PUTRI ARTHA X1736264

Traveller 6 SRI SUDIARTIN MUHAMMAD SENAT

DE Number Full Name (In Passport) Passport Number

Z9599R6213 SRI SUDIARTIN MUHAMMAD C1108335
SENAT

Traveller 7 MUHAMMAD BAYU FIRLYANSYAH

DE Number Full Name (In Passport) Passport Number

Z9599R6311 MUHAMMAD BAYU E2107340
FIRLYANSYAH

Traveller 8 MUTIA TRI RAMADHIAN

DE Number Full Name (In Passport) Passport Number

Z9599R6416 MUTIA TRI RAMADHIAN E2107357
Traveller 9 HILDIA RAHMADANI

DE Number Full Name (In Passport) Passport Number

Z9599R6519 HILDIA RAHMADANI C2098100

Traveller 10 CINDY CLARISSA DJAJASAPUTRA

DE Number Full Name (In Passport) Passport Number

Z9599R6617 CINDY CLARISSA E2106590
DJAJASAPUTRA
DE Number: Z9599R5710 VG

Personal Information
Full Name (In Passport)
JAWARA ANDRA PATRA

Sex Date of Birth

MALE 08/02/1996
Place of Residence
INDONESIA, RIAU ISLANDS, BATAM

Country/Place of Birth Nationality/Citizenship

INDONESIA INDONESIAN
Passport Number Date of Passport Expiry
X1893520 11/01/2033
Mobile Number Email Address
+62 85272233952 YUNI@THURAYYATOUR.COM

Trip Information
Date of Arrival in Singapore
20/01/2023
Mode of Travel
SEA
Mode of Travel (Details) Vessel Name
FERRY MAJESTIC
Type of Accommodation in Singapore Name of Hotel
HOTEL HOTEL BOSS
Last City / Port of Embarkation Before Singapore
INDONESIA, RIAU ISLANDS, BATAM
Next City / Port of Disembarkation After Singapore
INDONESIA, RIAU ISLANDS, BATAM
Date of Departure From Singapore
22/01/2023

Others
Have you ever used a passport under different name to enter Singapore? NO

Name different from current passport

DE Number: Z9599R5710 VG

Electronic Health Declaration (Lead Traveller)

Have you visited any of the listed countries in Africa or Latin America in the NO
past 6 days prior to your arrival in Singapore?

Did you start to have any symptoms in the last 7 days: fever, rash, cough, runny NO
nose, sore throat, loss of sense of smell, or shortness of breath?

Do you currently have fever, cough, shortness of breath, headache, or vomiting NO

AND have visited Africa or the Middle East in the past 14 days prior to your
arrival in Singapore?

Are you fully vaccinated with WHO-EUL vaccines against COVID-19? VACCINATED.

Remarks PLEASE PRODUCE

COVID-19 VACCINATION
CERTIFICATE FOR
CHECKS BY TRANSPORT
OPERATORS AND/OR
AUTHORITIES.
DE Number: Z9599R5813 VG

Personal Information
Full Name (In Passport)
YENI PURTIKA SIMANJUNTAK

Sex Date of Birth

FEMALE 26/07/1991
Place of Residence
INDONESIA, RIAU ISLANDS, BATAM

Country/Place of Birth Nationality/Citizenship

INDONESIA INDONESIAN
Passport Number Date of Passport Expiry
C9416823 09/06/2027
Mobile Number Email Address
+62 85272233952 YUNI@THURAYYATOUR.COM

Trip Information
Date of Arrival in Singapore
20/01/2023
Mode of Travel
SEA
Mode of Travel (Details) Vessel Name
FERRY MAJESTIC
Type of Accommodation in Singapore Name of Hotel
HOTEL HOTEL BOSS
Last City / Port of Embarkation Before Singapore
INDONESIA, RIAU ISLANDS, BATAM
Next City / Port of Disembarkation After Singapore
INDONESIA, RIAU ISLANDS, BATAM
Date of Departure From Singapore
22/01/2023

Others
Have you ever used a passport under different name to enter Singapore? NO

Name different from current passport

DE Number: Z9599R5813 VG

Electronic Health Declaration (Traveller 2)

Have you visited any of the listed countries in Africa or Latin America in the NO
past 6 days prior to your arrival in Singapore?

Did you start to have any symptoms in the last 7 days: fever, rash, cough, runny NO
nose, sore throat, loss of sense of smell, or shortness of breath?

Do you currently have fever, cough, shortness of breath, headache, or vomiting NO

AND have visited Africa or the Middle East in the past 14 days prior to your
arrival in Singapore?

Are you fully vaccinated with WHO-EUL vaccines against COVID-19? VACCINATED.

Remarks PLEASE PRODUCE

COVID-19 VACCINATION
CERTIFICATE FOR
CHECKS BY TRANSPORT
OPERATORS AND/OR
AUTHORITIES.
DE Number: Z9599R5911 VG

Personal Information
Full Name (In Passport)
JUNAIDI

Sex Date of Birth

MALE 23/12/1971
Place of Residence
INDONESIA, RIAU ISLANDS, BATAM

Country/Place of Birth Nationality/Citizenship

INDONESIA INDONESIAN
Passport Number Date of Passport Expiry
X1736265 05/01/2033
Mobile Number Email Address
+62 85272233952 YUNI@THURAYYATOUR.COM

Trip Information
Date of Arrival in Singapore
20/01/2023
Mode of Travel
SEA
Mode of Travel (Details) Vessel Name
FERRY MAJESTIC
Type of Accommodation in Singapore Name of Hotel
HOTEL HOTEL BOSS
Last City / Port of Embarkation Before Singapore
INDONESIA, RIAU ISLANDS, BATAM
Next City / Port of Disembarkation After Singapore
INDONESIA, RIAU ISLANDS, BATAM
Date of Departure From Singapore
22/01/2023

Others
Have you ever used a passport under different name to enter Singapore? NO

Name different from current passport

DE Number: Z9599R5911 VG

Electronic Health Declaration (Traveller 3)

Have you visited any of the listed countries in Africa or Latin America in the NO
past 6 days prior to your arrival in Singapore?

Did you start to have any symptoms in the last 7 days: fever, rash, cough, runny NO
nose, sore throat, loss of sense of smell, or shortness of breath?

Do you currently have fever, cough, shortness of breath, headache, or vomiting NO

AND have visited Africa or the Middle East in the past 14 days prior to your
arrival in Singapore?

Are you fully vaccinated with WHO-EUL vaccines against COVID-19? VACCINATED.

Remarks PLEASE PRODUCE

COVID-19 VACCINATION
CERTIFICATE FOR
CHECKS BY TRANSPORT
OPERATORS AND/OR
AUTHORITIES.
DE Number: Z9599R6018 VG

Personal Information
Full Name (In Passport)
YUMIANTI

Sex Date of Birth

FEMALE 23/04/1974
Place of Residence
INDONESIA, RIAU ISLANDS, BATAM

Country/Place of Birth Nationality/Citizenship

INDONESIA INDONESIAN
Passport Number Date of Passport Expiry
X1736263 05/01/2033
Mobile Number Email Address
+62 85272233952 YUNI@THURAYYATOUR.COM

Trip Information
Date of Arrival in Singapore
20/01/2023
Mode of Travel
SEA
Mode of Travel (Details) Vessel Name
FERRY MAJESTIC
Type of Accommodation in Singapore Name of Hotel
HOTEL HOTEL BOSS
Last City / Port of Embarkation Before Singapore
INDONESIA, RIAU ISLANDS, BATAM
Next City / Port of Disembarkation After Singapore
INDONESIA, RIAU ISLANDS, BATAM
Date of Departure From Singapore
22/01/2023

Others
Have you ever used a passport under different name to enter Singapore? NO

Name different from current passport

DE Number: Z9599R6018 VG

Electronic Health Declaration (Traveller 4)

Have you visited any of the listed countries in Africa or Latin America in the NO
past 6 days prior to your arrival in Singapore?

Did you start to have any symptoms in the last 7 days: fever, rash, cough, runny NO
nose, sore throat, loss of sense of smell, or shortness of breath?

Do you currently have fever, cough, shortness of breath, headache, or vomiting NO

AND have visited Africa or the Middle East in the past 14 days prior to your
arrival in Singapore?

Are you fully vaccinated with WHO-EUL vaccines against COVID-19? VACCINATED.

Remarks PLEASE PRODUCE

COVID-19 VACCINATION
CERTIFICATE FOR
CHECKS BY TRANSPORT
OPERATORS AND/OR
AUTHORITIES.
DE Number: Z9599R6115 VG

Personal Information
Full Name (In Passport)
TARISA PUTRI ARTHA

Sex Date of Birth

FEMALE 28/12/2001
Place of Residence
INDONESIA, RIAU ISLANDS, BATAM

Country/Place of Birth Nationality/Citizenship

INDONESIA INDONESIAN
Passport Number Date of Passport Expiry
X1736264 05/01/2033
Mobile Number Email Address
+62 85272233952 YUNI@THURAYYATOUR.COM

Trip Information
Date of Arrival in Singapore
20/01/2023
Mode of Travel
SEA
Mode of Travel (Details) Vessel Name
FERRY MAJESTIC
Type of Accommodation in Singapore Name of Hotel
HOTEL HOTEL BOSS
Last City / Port of Embarkation Before Singapore
INDONESIA, RIAU ISLANDS, BATAM
Next City / Port of Disembarkation After Singapore
INDONESIA, RIAU ISLANDS, BATAM
Date of Departure From Singapore
22/01/2023

Others
Have you ever used a passport under different name to enter Singapore? NO

Name different from current passport

DE Number: Z9599R6115 VG

Electronic Health Declaration (Traveller 5)

Have you visited any of the listed countries in Africa or Latin America in the NO
past 6 days prior to your arrival in Singapore?

Did you start to have any symptoms in the last 7 days: fever, rash, cough, runny NO
nose, sore throat, loss of sense of smell, or shortness of breath?

Do you currently have fever, cough, shortness of breath, headache, or vomiting NO

AND have visited Africa or the Middle East in the past 14 days prior to your
arrival in Singapore?

Are you fully vaccinated with WHO-EUL vaccines against COVID-19? VACCINATED.

Remarks PLEASE PRODUCE

COVID-19 VACCINATION
CERTIFICATE FOR
CHECKS BY TRANSPORT
OPERATORS AND/OR
AUTHORITIES.
DE Number: Z9599R6213 VG

Personal Information
Full Name (In Passport)
SRI SUDIARTIN MUHAMMAD SENAT

Sex Date of Birth

FEMALE 31/10/1963
Place of Residence
INDONESIA, RIAU ISLANDS, BATAM

Country/Place of Birth Nationality/Citizenship

INDONESIA INDONESIAN
Passport Number Date of Passport Expiry
C1108335 02/08/2023
Mobile Number Email Address
+62 85272233952 YUNI@THURAYYATOUR.COM

Trip Information
Date of Arrival in Singapore
20/01/2023
Mode of Travel
SEA
Mode of Travel (Details) Vessel Name
FERRY MAJESTIC
Type of Accommodation in Singapore Name of Hotel
HOTEL HOTEL BOSS
Last City / Port of Embarkation Before Singapore
INDONESIA, RIAU ISLANDS, BATAM
Next City / Port of Disembarkation After Singapore
INDONESIA, RIAU ISLANDS, BATAM
Date of Departure From Singapore
22/01/2023

Others
Have you ever used a passport under different name to enter Singapore? NO

Name different from current passport

DE Number: Z9599R6213 VG

Electronic Health Declaration (Traveller 6)

Have you visited any of the listed countries in Africa or Latin America in the NO
past 6 days prior to your arrival in Singapore?

Did you start to have any symptoms in the last 7 days: fever, rash, cough, runny NO
nose, sore throat, loss of sense of smell, or shortness of breath?

Do you currently have fever, cough, shortness of breath, headache, or vomiting NO

AND have visited Africa or the Middle East in the past 14 days prior to your
arrival in Singapore?

Are you fully vaccinated with WHO-EUL vaccines against COVID-19? VACCINATED.

Remarks PLEASE PRODUCE

COVID-19 VACCINATION
CERTIFICATE FOR
CHECKS BY TRANSPORT
OPERATORS AND/OR
AUTHORITIES.
DE Number: Z9599R6311 VG

Personal Information
Full Name (In Passport)
MUHAMMAD BAYU FIRLYANSYAH

Sex Date of Birth

MALE 30/11/1996
Place of Residence
INDONESIA, RIAU ISLANDS, BATAM

Country/Place of Birth Nationality/Citizenship

INDONESIA INDONESIAN
Passport Number Date of Passport Expiry
E2107340 11/01/2033
Mobile Number Email Address
+62 85272233952 YUNI@THURAYYATOUR.COM

Trip Information
Date of Arrival in Singapore
20/01/2023
Mode of Travel
SEA
Mode of Travel (Details) Vessel Name
FERRY MAJESTIC
Type of Accommodation in Singapore Name of Hotel
HOTEL HOTEL BOSS
Last City / Port of Embarkation Before Singapore
INDONESIA, RIAU ISLANDS, BATAM
Next City / Port of Disembarkation After Singapore
INDONESIA, RIAU ISLANDS, BATAM
Date of Departure From Singapore
22/01/2023

Others
Have you ever used a passport under different name to enter Singapore? NO

Name different from current passport

DE Number: Z9599R6311 VG

Electronic Health Declaration (Traveller 7)

Have you visited any of the listed countries in Africa or Latin America in the NO
past 6 days prior to your arrival in Singapore?

Did you start to have any symptoms in the last 7 days: fever, rash, cough, runny NO
nose, sore throat, loss of sense of smell, or shortness of breath?

Do you currently have fever, cough, shortness of breath, headache, or vomiting NO

AND have visited Africa or the Middle East in the past 14 days prior to your
arrival in Singapore?

Are you fully vaccinated with WHO-EUL vaccines against COVID-19? VACCINATED.

Remarks PLEASE PRODUCE

COVID-19 VACCINATION
CERTIFICATE FOR
CHECKS BY TRANSPORT
OPERATORS AND/OR
AUTHORITIES.
DE Number: Z9599R6416 VG

Personal Information
Full Name (In Passport)
MUTIA TRI RAMADHIAN

Sex Date of Birth

FEMALE 03/02/1996
Place of Residence
INDONESIA, RIAU ISLANDS, BATAM

Country/Place of Birth Nationality/Citizenship

INDONESIA INDONESIAN
Passport Number Date of Passport Expiry
E2107357 11/01/2033
Mobile Number Email Address
+62 85272233952 YUNI@THURAYYATOUR.COM

Trip Information
Date of Arrival in Singapore
20/01/2023
Mode of Travel
SEA
Mode of Travel (Details) Vessel Name
FERRY MAJESTIC
Type of Accommodation in Singapore Name of Hotel
HOTEL HOTEL BOSS
Last City / Port of Embarkation Before Singapore
INDONESIA, RIAU ISLANDS, BATAM
Next City / Port of Disembarkation After Singapore
INDONESIA, RIAU ISLANDS, BATAM
Date of Departure From Singapore
22/01/2023

Others
Have you ever used a passport under different name to enter Singapore? NO

Name different from current passport

DE Number: Z9599R6416 VG

Electronic Health Declaration (Traveller 8)

Have you visited any of the listed countries in Africa or Latin America in the NO
past 6 days prior to your arrival in Singapore?

Did you start to have any symptoms in the last 7 days: fever, rash, cough, runny NO
nose, sore throat, loss of sense of smell, or shortness of breath?

Do you currently have fever, cough, shortness of breath, headache, or vomiting NO

AND have visited Africa or the Middle East in the past 14 days prior to your
arrival in Singapore?

Are you fully vaccinated with WHO-EUL vaccines against COVID-19? VACCINATED.

Remarks PLEASE PRODUCE

COVID-19 VACCINATION
CERTIFICATE FOR
CHECKS BY TRANSPORT
OPERATORS AND/OR
AUTHORITIES.
DE Number: Z9599R6519 VG

Personal Information
Full Name (In Passport)
HILDIA RAHMADANI

Sex Date of Birth

FEMALE 26/03/1992
Place of Residence
INDONESIA, RIAU ISLANDS, BATAM

Country/Place of Birth Nationality/Citizenship

INDONESIA INDONESIAN
Passport Number Date of Passport Expiry
C2098100 19/11/2023
Mobile Number Email Address
+62 85272233952 YUNI@THURAYYATOUR.COM

Trip Information
Date of Arrival in Singapore
20/01/2023
Mode of Travel
SEA
Mode of Travel (Details) Vessel Name
FERRY MAJESTIC
Type of Accommodation in Singapore Name of Hotel
HOTEL HOTEL BOSS
Last City / Port of Embarkation Before Singapore
INDONESIA, RIAU ISLANDS, BATAM
Next City / Port of Disembarkation After Singapore
INDONESIA, RIAU ISLANDS, BATAM
Date of Departure From Singapore
22/01/2023

Others
Have you ever used a passport under different name to enter Singapore? NO

Name different from current passport

DE Number: Z9599R6519 VG

Electronic Health Declaration (Traveller 9)

Have you visited any of the listed countries in Africa or Latin America in the NO
past 6 days prior to your arrival in Singapore?

Did you start to have any symptoms in the last 7 days: fever, rash, cough, runny NO
nose, sore throat, loss of sense of smell, or shortness of breath?

Do you currently have fever, cough, shortness of breath, headache, or vomiting NO

AND have visited Africa or the Middle East in the past 14 days prior to your
arrival in Singapore?

Are you fully vaccinated with WHO-EUL vaccines against COVID-19? VACCINATED.

Remarks PLEASE PRODUCE

COVID-19 VACCINATION
CERTIFICATE FOR
CHECKS BY TRANSPORT
OPERATORS AND/OR
AUTHORITIES.
DE Number: Z9599R6617 VG

Personal Information
Full Name (In Passport)
CINDY CLARISSA DJAJASAPUTRA

Sex Date of Birth

FEMALE 23/11/1999
Place of Residence
INDONESIA, RIAU ISLANDS, BATAM

Country/Place of Birth Nationality/Citizenship

INDONESIA INDONESIAN
Passport Number Date of Passport Expiry
E2106590 06/01/2033
Mobile Number Email Address
+62 85272233952 YUNI@THURAYYATOUR.COM

Trip Information
Date of Arrival in Singapore
20/01/2023
Mode of Travel
SEA
Mode of Travel (Details) Vessel Name
FERRY MAJESTIC
Type of Accommodation in Singapore Name of Hotel
HOTEL HOTEL BOSS
Last City / Port of Embarkation Before Singapore
INDONESIA, RIAU ISLANDS, BATAM
Next City / Port of Disembarkation After Singapore
INDONESIA, RIAU ISLANDS, BATAM
Date of Departure From Singapore
22/01/2023

Others
Have you ever used a passport under different name to enter Singapore? NO

Name different from current passport

DE Number: Z9599R6617 VG

Electronic Health Declaration (Traveller 10)

Have you visited any of the listed countries in Africa or Latin America in the NO
past 6 days prior to your arrival in Singapore?

Did you start to have any symptoms in the last 7 days: fever, rash, cough, runny NO
nose, sore throat, loss of sense of smell, or shortness of breath?

Do you currently have fever, cough, shortness of breath, headache, or vomiting NO

AND have visited Africa or the Middle East in the past 14 days prior to your
arrival in Singapore?

Are you fully vaccinated with WHO-EUL vaccines against COVID-19? VACCINATED.

Remarks PLEASE PRODUCE

COVID-19 VACCINATION
CERTIFICATE FOR
CHECKS BY TRANSPORT
OPERATORS AND/OR
AUTHORITIES.