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flt529 1 18apr2025

This document is a General Declaration for an Air Asia flight from Bandar Seri Begawan, Brunei to Jakarta, Indonesia. It includes details about the aircraft, passengers, and health declarations. The declaration confirms that all information provided is accurate and that passengers will continue on the flight.

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Edwar Zulmi
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17 views1 page

flt529 1 18apr2025

This document is a General Declaration for an Air Asia flight from Bandar Seri Begawan, Brunei to Jakarta, Indonesia. It includes details about the aircraft, passengers, and health declarations. The declaration confirms that all information provided is accurate and that passengers will continue on the flight.

Uploaded by

Edwar Zulmi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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General ICAO ANNEX 9

APPENDIX 1
Declaration

(OUTWARD/INWARD)

Operator Air Asia - Indonesia Aircraft QZ20

Marks of Nationality and Registration PK-AZL Flight QZ529 Date 18/04/25

Departure from BANDAR SERI BEGAWAN, (BRUNEI Arrival at JAKARTA, SOEKARNO HATTA INTL (INDONESIA)
DARUSSALAM)

FLIGHT ROUTING
(*Airport:* Column always to list origin, every en-routing stop and destination)
Passport No. Of Passengers
Port Name Pos Passport Birth Date G Ntly
Expiry on this stage
BWN JULIAN HENDRA CP X1447101 11/07/91 M IDN 21/09/33 Departure Place: BWN

to RIFQI VANSER NAMILANO FO C8556501 08/09/93 M IDN 11/05/27

CGK TRIA ANGGRAENY WINARDI SC X1446232 24/02/85 F IDN 04/09/33 Embarking:

RATIKA ARIANI CC C9462733 23/09/94 F IDN 29/06/27

MUJIBUR RAHMAN SARDER CC E3955725 14/02/97 M IDN 18/07/33 Through on same flight:

VANDRO CHRISTOFER PIRING CC E2850255 29/04/88 M IDN 14/04/33

SYAIFULLAH SYAIFULLAH DXR E0004154 10/02/86 M IDN 09/08/27 Arrival Place: CGK

SURYADI SURYADI JS E4076097 11/12/85 M IDN 14/07/33

EDWAR ANDY ZULMI JS E6740735 21/07/88 M IDN 07/03/34 Disembarking:

Through on same flight:

DECLARATION OF HEALTH FOR OFFICIAL USE ONLY


Name and seat number or function of persons on board with illnesses other than airsicknesses or the effects of
accidents, who may be suffering from a communicable disease ( a fever- temperature 38øC/100øF or greater-
associated with one or more or the following signs or symptoms, e.g. appearing obviously unwell;persistent
coughing;persistent vomiting;skin rash; bruising or bleeding without previous injury; or confusion of recent onset,
increases the likelihood that the person is suffering a communicable disease) as well as such cases of illness
disembarked during a previous stop .............................................................................................................................

Details of each disincecting or sanitary treatment(place, date, time, method) during the flight. If no dinsecting has been
carried out during the flight,give details of most recent disinsecting ..................................................................

Signed, if required, with time and date


Crew member concerned

I declare that all statements and particulars contained in this General Declaration and in any supplementary forms required to be presented with
this General Declaration are complete exact and true to the best of my knowledge and that all through passengers will continue/have continued
on the flight.

Signature
Authorized Agent or Pilot-In-Command
Delete as necessary

REMARKS:

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