Checkin Form

Please fill all of field of checkin form. And thank you to Join the Republic


PERSONAL INFORMATION
Name *
Email *
Date of Birth*
Phone
Passport Number*
Nationality of Passport*
TRIP INFORMATION
Invoice Num*
Booking Num*
Trip Date*
Arrival Date*
Packages*
Location to Meet Us*
Marine Park Fee*
DIVE EQUIPMENT
Do you have your own equipment or want to rent?*
BCD
Regulator
Wetsuit
Mask
Snorkel
Dive Computer
Fins
Boots
Torch
EMERGENCY INFORMATION
Emergency Contact Name*
Email*
Phone*
Status of Emergency Contact*
INSURANCE INFORMATION
Insurance Company
Policy Number
Emergency Contact
DIVE INFORMATION
How many dive do you have?*
When was your last dive?*
What is your certification level?*
MEDICAL INFORMATION
Have you ever had asthma?*
Do you have any heart conditions?*
Do you have diabetes or other endocrinal maladies?*
Do you have epilepsy or any other conditions that affect your consciousness / attention?*
Are you suffering from high blood pressure?*
Are you currently on any medication?* (except anti-malaria or anti-conception medication)?
Are you medically fit to dive/snorkel?*
OTHER INFORMATION
Please let us know if you have any special food or dietary requirements?*
How did you hear about us?
Your Passport Image (jpg, JPG, PNG < 10MB)


Info:
Departure day
As domestic flights in Indonesia are known to be unreliable we recommend
that you plan to arrive in Raja Ampat the day before and plan to leave the day after.

If you prefer to arrive on departure date you may need to be in Meridian Hotel 07.00 and send us a copy of your passport a weeks before departure in order to process imigration document and harbormaster clearance.
If you Arrive in Waisai Airport Meeting point will be in Waisai Harbor 11.00

Guests meet in meridian hotel lobby at 7 am and transferred ferry to Waisai at 9 am and Waisi to board jaya 11am
approx 11am. Cabins allocated boat briefing setting up of equipment.

Arrive Waisai approx 12pm have small lunch and than board ferry to sorong around 2pm