Bali, 11th Januari 2024

Nomor : 108/SP-HO/CE/I-24
Perihal : Pemberitahuan Kunjungan Wisatawan Manca Negara ke Agats, Asmat
Lampiran : 1(satu) Daftar nama wisatawan dan data passport.

Kepada Yang Terhormat

Kapolres Kabupaten Asmat
Di – Agats, Asmat

Dengan Hormat,

Bersama ini kami sampaikan kepada Bapak/Ibu sehubungan dengan rencana kunjungan wisatawan manca
negara ke Agats Kabupaten Asmat dengan menggunakan Kapal wisata MV.Coral Adventurer.
Hari/Tanggal/Bulan : Sabtu – Minggu, 10 -11 February 2024
Jumlah Wisatawan : 101 Orang [90 Guests &11 Staffs]
Kewarganegaraan : Australia, Amerika Serikat, Perancis, Belgia, Irlandia,UK (terlampir data
kewarganegaraan)
Maksud kunjungan : Murni kunjungan wisata
Waktu kunjungan : 07:00 – RON – 10:30

Berkenaan dengan maksud tersebut, kami mohon bantuan,dukungan pengamanan beserta instansi terkait
lainnya guna menyukseskan kunjungan dimaksud.

Sehubungan dengan keterbatasan waktu kunjungan maka pilihan tempat-tempat wisata yang akan di
kunjungi selama berada di Agats, Asmat antara lain: Kampung Syuru, Kota Agats & Sekitarnya

Demikian pemberitahuan ini kami sampaikan kehadapan Bapak/Ibu, atas bantuan, dukungan dan kerjasama
yang baik kami haturkan limpah terima kasih.

Hormat kami

Mega Maya
Managing Director

HEAD OFFICE BALI OFFICE

PT. MOZAIK WISATA PAPUA
Jl. Bima, Distrik Sorong Utara Alamanda Building 5th Floor
Kel. Matalamagi, Sorong, Papua Barat 98416 Jl. Bypass Ngurah Rai No.60 Badung, Bali
Ph. +62 811 399 2000 Ph. +62 361 2003044

info@signaturepapua.com | www.signaturepapua.com
 Booking First Middle Passport
N0. Surname Title Nationality Expiry Date Date of Birth Age
Number Name Name Number
1523272890 Austin Tony Kenneth 0Mr Australia PA8416522 08 December 29 December 70
1 2027 1953
1523272890 Austin Catherine Jean 1Mrs Australia PB5662772 08 13 July 1952 71
2 September
2032
1523277880 Benson Mark Douglas 0Mr Australia PA7510625 12 July 2028 21 May 1948 75
3

1523277880 Benson Susan Margaret 1Mrs Australia PB1016867 09 July 2028 27 August 75
4 1948
1522247954 Bessell- Jane Margaret 1Mrs Australia PA7533807 12 November 03 November 61
5 Browne 2028 1962
1522247954 Bessell- Philip Andrew 0Mr Australia PA4644582 27 July 2026 28 June 1960 63
6 Browne
1523322904 Blessley Scott David 0Mr United 642795787 26 March 22 January 66
7 States 2031 1957
1522228601 Bradshaw Simon John 0Mr Australia PA4110475 21 April 2026 16 July 1958 65
8

1522228601 Bradshaw Margaret Ruth 1Mrs Australia PA8706534 18 December 29 January 63

9 2027 1960
1523314222 Cassedy Debra Kay 2Ms United 550904020 15 August 05 April 1957 66
10 States 2026
1522220527 Chandler Ewan John 0Mr Australia PB5114241 01 July 2032 28 March 63
11 1960
1523320107 Christian David Frank 0Mr Australia PB1381886 29 May 2029 22 June 1949 74
12

1523322153 Cornelius Lucy Anna 3Miss Australia PB6240544 24 August 27 April 2003 20
13 2032
1523279311 Cornelius Kathryn Mary 1Mrs Australia RA4254355 05 30 October 51
14 September 1972
2033
1523279311 Cornelius Bridget Jillian 3Miss Australia RA4055118 20 10 June 2010 13
15 September
2028
1523279311 Cornelius Samantha Amy 3Miss Australia PA5917854 23 May 2026 06 April 2000 23
16

1523295160 Danks Janine Athalie 2Ms Australia PB2974109 21 January 24 April 1954 69
17 2030
1522228325 Dickinson William James 0Mr Australia PA3287730 07 March 27 January 71
18 2026 1952
1522228325 Dickinson Deborah 1Mrs Australia PB3513084 14 March 27 June 1952 71
19 2026
1522230962 Fernance Barry Eric 0Mr Australia PB4501732 27 February 10 May 1950 73
20 2030
1522230962 Fernance Janice Robina 1Mrs Australia PB4501703 27 February 22 November 72
21 2030 1951
1522183130 Flynn Jo-anne 1Mrs Australia RA2086839 24 January 21 February 66
22 2033 1957
1522183130 Flynn Barry James 0Mr Australia RA1446095 25 January 02 November 67
23 2033 1956
Fryer Clara Jean 1Mrs Australia RA5208359 15 November 22 November 32
24 2033 1991
1523319936 Grose Ian Sidney 0Mr Australia PA9441812 10 April 2028 07 July 1941 82
25

HEAD OFFICE BALI OFFICE

PT. MOZAIK WISATA PAPUA
Jl. Bima, Distrik Sorong Utara Alamanda Building 5th Floor
Kel. Matalamagi, Sorong, Papua Barat 98416 Jl. Bypass Ngurah Rai No.60 Badung, Bali
Ph. +62 811 399 2000 Ph. +62 361 2003044

info@signaturepapua.com | www.signaturepapua.com
 1523319936 Grose Gillian 1Mrs Australia PA4597148 24 June 2026 13 April 1950 73
26

1523321312 Hausle Michael Allie 0Mr United 552081508 13 November 03 December 78

27 States 2026 1945
1523321312 Hausle Carol Jean 1Mrs United 552081510 13 November 21 July 1946 77
28 States 2026
1523279311 Henderson Jillian May 1Mrs Australia PA8749650 31 May 2028 10 May 1942 81
29

1522228243 Hobbs Sophie Catherine 1Mrs United 566676334 10 April 2029 23 August 65
30 States 1958
1522228243 Hobbs H Kendall 0Mr United 666713477 13 April 2031 08 October 78
31 States 1945
1522228253 Holliday Jenny Louise 2Ms Australia RA3236896 21 June 2033 04 May 1956 67
32

1522228253 Holliday Richard Peter 0Mr Australia RA3236994 21 June 2033 19 October 69
33 1954
1523322904 Hornbach Katherine Marie 2Ms United 567630289 11 November 07 May 1956 67
34 States 2029
1523320150 Hudspith Sandra Mary DR Australia PA3857609 14 April 2026 29 September 76
35 1947
1523313795 Isaacs Jeffery George 0Mr Australia PB2384254 02 02 December 87
36 September 1936
2024
1522175723 Jacob Jean Yves Alain 0Mr France 22CE74669 18 May 2025 31 March 63
37 Marie 1960
1521143901 Jones Julianne Mary 2Ms Australia PB5591627 30 April 2031 22 January 68
38 1955
1523284402 Kell John Findlay 0Mr Australia PB2138238 25 November 09 March 71
39 2029 1952
1523284402 Kell Elizabeth Sally 1Mrs Australia PB2138755 25 November 02 April 1952 71
40 2029
1522219620 Luebben Susan Marie 1Mrs United 568058076 20 November 20 June 1964 59
41 Maddox States 2030
1522268268 Lukacs Steven 0Mr Australia PA5470874 05 May 2026 30 May 1954 69
42

1522268268 Lukacs Judith Anne 1Mrs Australia PB5493407 07 October 12 April 1956 67
43 2032
1522219620 Maddox George Inwon 0Mr United A03913886 18 May 2032 14 July 1960 63
44 States
1523320807 McKay Noel Douglas 0Mr Australia PB2686593 15 25 February 67
45 September 1956
2031
1522213862 McKirdy Archibald John 0Mr Australia PA6889917 02 July 2028 26 January 79
46 1944
1522213862 McKirdy Enid Elaine 1Mrs Australia PA6889877 02 July 2028 04 September 78
47 1945
1522175723 Montens Laurence Sandrine 1Mrs Belgium ES549324 12 November 02 May 1969 54
48 d'Oosterwyck 2026
1522229785 Moritz Judith Audrey 1Mrs Australia PA6288830 04 18 February 71
49 September 1952
2027
1522229785 Moritz Graham Frederick 0Mr Australia PA6288495 04 13 September 75
50 September 1948
2027
1521143901 Mottershead Karyn Jean 2Ms Australia PA8193987 28 August 07 October 62
51 2027 1961

HEAD OFFICE BALI OFFICE

PT. MOZAIK WISATA PAPUA
Jl. Bima, Distrik Sorong Utara Alamanda Building 5th Floor
Kel. Matalamagi, Sorong, Papua Barat 98416 Jl. Bypass Ngurah Rai No.60 Badung, Bali
Ph. +62 811 399 2000 Ph. +62 361 2003044

info@signaturepapua.com | www.signaturepapua.com
 1522229102 Mullaney Paul Brian 0Mr Ireland PH0518853 10 January 30 October 66
52 2032 1957
1522229102 Mullaney Mary Catherine 1Mrs Ireland PG7754749 17 November 24 November 66
53 2032 1957
1523312668 Murray Dean Christophe DR Australia PB2682827 14 03 December 64
54 r September 1959
2031
1523312668 Murray Ria 1Mrs Australia PA2138028 18 June 2025 24 January 64
55 1959
1522220527 Newton- Sally Ann 0Mr Australia PB5114115 01 July 2032 17 September 54
56 Chandler 1969
1523283444 Northwood John 0Mr United 556668263 27 02 July 1947 76
57 Kingdom September
2028
1522166446 O'Dell Martin DR Australia PA8711311 19 December 24 February 78
58 2027 1945
1522166446 O'Dell Robyn Joan 1Mrs Australia PA2743256 10 23 June 1948 75
59 September
2025
1522228444 Penrose Margaret Anne 1Mrs Australia PB1289012 24 June 2030 02 August 73
60 1950
1522228444 Penrose John Winston 0Mr Australia RA1683283 23 November 14 March 74
61 2032 1949
1522262164 Pepperdine John Michael 0Mr Australia PB4545172 29 November 12 February 78
62 2031 1945
1522262164 Pepperdine Sandra Judith 1Mrs Australia PB4545112 29 November 06 March 74
63 2031 1949
1523283444 Plautz Laurie Sue 2Ms United 548490096 11 October 13 February 62
64 States 2026 1961
1523320807 Ramsay- Glenda Inez 1Mrs Australia PB4523785 23 November 02 November 66
65 Mckay 2031 1957
1522259639 Robinson Brian William 0Mr Australia PA2624089 07 24 December 78
66 September 1945
2025
1522259639 Robinson Carol Patricia 1Mrs Australia PA2775576 02 15 March 66
67 September 1957
2025
1523314222 Sambell Warren Douglas 0Mr Australia PB4159266 25 June 2030 29 April 1960 63
68

1522219418 Smith Cynthia June 1Mrs Australia PB2634591 11 January 04 June 1947 76
69 2031
1522219418 Smith Donald Frank 0Mr Australia PB2632689 08 January 25 March 80
70 Burnett 2031 1943
1522219620 Stock-Stone Susan Rae 1Mrs United 548665574 15 May 2027 01 December 69
71 States 1954
1522219620 Stone Sr Stephen 0Mr United 548665575 15 May 2027 16 October 69
72 States 1954
1523271698 Surace George Roy 0Mr Australia PB3788973 29 January 26 April 1954 69
73 2030
1523271698 Surace Rosalind Grace 1Mrs Australia PB3789200 29 January 13 September 68
74 2030 1955
1522145869 Swainston Robin DR Australia PE0404953 22 18 January 66
75 September 1957
2026
1522145869 Swainston Diane Maree 1Mrs Australia PE0404923 22 01 November 69
76 September 1954
2026
1523313592 Tacey Warren Howard 0Mr Australia PB2869835 03 February 12 October 70
77 2030 1953

HEAD OFFICE BALI OFFICE

PT. MOZAIK WISATA PAPUA
Jl. Bima, Distrik Sorong Utara Alamanda Building 5th Floor
Kel. Matalamagi, Sorong, Papua Barat 98416 Jl. Bypass Ngurah Rai No.60 Badung, Bali
Ph. +62 811 399 2000 Ph. +62 361 2003044

info@signaturepapua.com | www.signaturepapua.com
 1523281694 Thompson Edward Barry DR Australia PA9878387 25 March 19 December 76
78 2029 1947
1523319457 Vestby Rosina Eugenie 1Mrs Australia PA7721037 04 May 2027 14 February 75
79 1948
1523319457 Vestby Oddmar 0Mr Australia RA4121628 06 October 10 August 77
80 2033 1946
1522159230 Ward Stephen Charles 0Mr Australia PE0415071 13 June 2027 11 May 1956 67
81

1522159230 Ward Rhonda Maureen 1Mrs Australia PE0414949 14 June 2027 09 April 1959 64
82

1523313592 Watts Julie Maree 2Ms Australia RA2169753 17 January 11 February 57

83 2033 1966
1523320107 Weedon Sally Anne 2Ms Australia PA3877162 21 April 2026 04 April 1957 66
84

1522229876 Willison David Lindsay 0Mr Australia RA3695263 01 November 16 September 69

85 2033 1954
1522229876 Willison Joanne 1Mrs Australia PA4516044 11 March 15 June 1953 70
86 2026
1522229391 Wilson Anne DR Australia RA4763694 07 December 24 April 1953 70
87 2033
1522229391 Wood John Norman 0Mr Australia RA4713157 23 November 20 August 78
88 2033 1945
1522230019 Wynen Peter Wilhelmus 0Mr Australia PA3095976 10 February 11 December 70
89 2026 1953
1522230019 Wynen Arrienne Faith 1Mrs Australia RA2446480 20 March 09 April 1955 68
90 2033

Booking First Middle Passport

No. Surname Title Nationality Expiry Date Date of Birth Age
Number Name Name Number
Guest Andrews Raymond John 0Mr Australia PB4914310 15 November 26 December 57
1 Lecturer 2031 1966
Guest Kidu Carol Anne 1Mrs Australia PB2965406 16 January 10 October 75
2 Lecturer 2030 1948
Guest O'Dea Anne Mary 2Ms Australia PA1462078 09 April 2025 10 May 1962 61
3 Lecturer
Guest Sugden Michael James 0Mr Australia RA2899836 30 May 2033 23 December 75
4 Lecturer 1948
Guest Winderlich Stephen Michael 0Mr Australia PB3992486 16 April 2031 11 November 63
5 Lecturer 1960

Exped. 10 January
6 SINGLETON Dawn Mrs Australia 21 June 1977
Leader 2032
Asst. Exp. 04 December 18 October
7 HOWARD Amber Mrs Australia PB1533204
Leader 2029 2000
14 November 26 November
8 Exped. Crew GARRONE Marie Mrs Australia PA8685194
2027 1971
19 November
9 Exped. Crew JONGENS Luke Mr Australia RA2745371 18 April 2033
1994
15 November
10 Exped. Crew WOOLCOTT Adam Mr Australia PA7090950 15 May 2000
2026
Dive 25 December
11 SCHWARTZ Christina Mrs Australia PB4829585 27 April 2032
Instructor 1993

HEAD OFFICE BALI OFFICE

PT. MOZAIK WISATA PAPUA
Jl. Bima, Distrik Sorong Utara Alamanda Building 5th Floor
Kel. Matalamagi, Sorong, Papua Barat 98416 Jl. Bypass Ngurah Rai No.60 Badung, Bali
Ph. +62 811 399 2000 Ph. +62 361 2003044

info@signaturepapua.com | www.signaturepapua.com