Responses cannot be edited
Contact information
Banyak's Nauli Surf Charters guest information form
Please review the Banyaks Nauli Surf Charters Terms and Conditions at - to complete this form you must accept the terms and conditions.
We need this information from you for authorities in Indonesia and to ensure we can host you in the Banyak Islands. We won't give this information to anyone else. We can't accept you on the boat until this form is completed in full - questions with a red asterix are compulsory. We require this information 60 days before departure to ensure a smooth charter.

Please email if you have any questions or need any help
Note * required information

Name as it appears on passport
Boat trip departure date *
Photography package with professional photographer ? *
Nationality on passport
Passport number
Passport expiry date Note that you require 6 months validity to enter Indonesia.
Date of birth
Contact email address *
Emergency contact * Family or friend - please specify relationship e.g. Mary (spouse): +61 555 555-5555
Insurance DetailsCompany , policy # and emergency contact number e.g. " World Nomands, Policy WNNZL11003839, +44 (0)20 7902 7405"Your answer
Date and Time of Arrival in Medan/Kuala Namu before Trip * (If you are coming by ferry or overland, please put time of arrival at port)
Arrival Flight Number and Booking Reference (e.g. MI234, FHCRTW)
Date and Time of Departure from Medan/Kuala Namu after trip (If you are coming by ferry or overland, please put time of departure from port)
Departure Flight Number and Booking Reference (e.g. MI235, FHCRTW)
Board Cover Please advise length of your board bag - e.g. 7'6" or 2.28m. If you are bringing more than one bag please let us know.Your answer
Hotels in Medan and domestic flights if required. Please let us know any details about your hotel bookings - e.g. who you're sharing with, special requirements, etc.
Special Dietary or Health Requirements. Please let us know about any allergies, dietary preferences or health issues we need to be aware of (if any). We will do our best to accommodate your requests.
Where did you hear about us? It'd be great to know how you found out about us - agent, customer, facebook, web, ad, etc.
I have read and understood The terms and Conditions *Terms and conditions can be seen at
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Additional Terms