PROFORMA

(MoP&NG/ONGC/DGH)
(Foreign nationals including Crew)
I. Name of the Foreigner (in capital letters

: SYARLI WELLMAN

With surname underlined)

2. Father's Name

: SYAHRIL SAHAR

3. Place/Country and Date of birth

: DURI, 19 JUNE 1979

4. Nationality 1) Present

: INDONESIAN
: INDONESIAN
: QC INSPECTOR

2) Past
5. Occupation (Address of employer, if employed)
6. Present Address

7. Permanent Address

Photogra
ph

: M/S. SWIBER OFFSHORE CONSTRUCTION

PTE LTD.
502-B WING, DELPHI, HIRANANDANI
GARDENS, POWAI, MUMBAI -76.
: Perum. Telaga Sakinah Block CD 19/4
RT/RW: 04/10, Kel. Telaga Murni, Cikarang,
Indonesia

8. Reference

a) In country of applicant
b) In India

: Mr. ENGELBERT DSILVA

: MR. NITIN SINGH

9. Passport details a) Number

:
:
:
:
:

b) Issued at (place/country)
c) Date of Issue
d) Valid up to
10.Details of Visa for India, if obtained
No.__________ Issued by________
At ___________ Valid Until ________

A 7337278
Republic of Indonesia
22 January 2014
22 January 2019
UNDER PROCESS

11. Places of Visit

: ONGC MUMBAI HIGH OFFSHORE FIELD

12. Purpose of Visit

: TO JOIN SWIBER VESSELS/BARGES

13. Port of Entry into India

: MUMBAI

14. Likely date of visit

: 1ST WEEK OF APRIL, 2015

15. Duration of visit

: 1 YEAR

16.Details of previous visits to India, if any

: No

17. Has he/she /they previously visited any restricted

area or protected area in India? If so details thereof

: No

18. Has any earlier request for the permit/VISA been

: No

refused? If so, details thereof

The information given above is correct to and complete to the best of my knowledge.
Dated:
Signature of applicant
Place: