Surfbanyak Customer Info Form
Please review the Surf Banyak Terms and Conditions at http://www.surfbanyak.com/terms-and-conditions/ - 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. If we don't receive your flight details 60 days before departure we can't guarantee your domestic flights.

Please email info@surfbanyak.com if you have any questions or need any help - cheers!

Full Name *
Enter as it is on passport with Surname/Family Name first, e.g. SMITH, Joseph James
Your answer
Preferred Name
e.g. Joe
Your answer
Boat and Trip Departure Date *
Photography Package? *
You can have professional photographer document your trip.
Nationality on passport *
(e.g. Australian)
Your answer
Passport Number *
Your answer
Passport Expiry Date *
Note that you require 6 months validity to enter Indonesia.
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Date of Birth *
MM
/
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YYYY
Contact email address *
(If you are an agent, your email)
Your answer
Phone contact *
preferably mobile, include country code e.g. +61 415 389 584
Your answer
Emergency contact *
Family or friend - please specify relationship e.g. Rhonda (mother): +61 555 555-5555
Your answer
Insurance Details
Company, 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)
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DD
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YYYY
Time
:
Arrival Flight Number and Booking Reference *
(e.g. MI234, FHCRTW)
Your answer
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)
MM
/
DD
/
YYYY
Time
:
Departure Flight Number and Booking Reference *
(e.g. MI235, FHCRTW)
Your answer
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
Hotel - Arriving in Medan *
Please advise your booked hotel in Medan if you are staying overnight - we'll pick you up from the airport and drop you there. If you're travelling to the Seriti on the same day you arrive and are not staying in a hotel, please write NONE. Many guests stay at the Marriott, Swiss-Belhotel, or Wings Hotel - these can all be booked via the usual hotel websites such as Booking.com.
Your answer
Hotels - Departing from Medan *
Please advise your booked hotel in Medan if you are staying overnight on departure- we'll drop you there after your connection from the Seriti and take you out to the airport the next day. If you're leaving the same day you're leaving the Seriti and are not staying in a hotel, please write NONE.
Your answer
Hotels - Anything else we need to know?
Please let us know any details about your hotel bookings - e.g. who you're sharing with, special requirements, etc.
Your answer
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.
Your answer
Alcohol order
Non-alcoholic drinks are included, basic spirits are $US50/bottle; beer is $US40/carton (24 cans); wine is $40/bottle. If you are ordering for your group please make sure your group knows this and doesn't double up!
Your answer
Where did you hear about us?
It'd be great to know how you found out about us - agent, customer, facebook, web, ad, etc.
Your answer
I have read and understood The terms and Conditions *
Terms and conditions can be seen at http://www.surfbanyak.com/terms-and-conditions/
Required
That's it! Please click the "Submit" button below to send your information. Thanks and we look forward to hosting you in the Banyaks!
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