PDO Registration Form

Name of Dive Centre/ Operator*:
Diving Area*: Aceh Padang, Mentawai, Nias Batam, Bintan, Lingga, Natuna, Anambas Krakatau, Banten, Kepulauan Seribu Pelabuhan Ratu Karimun Jawa Jawa Timur Bali Lombok Komodo Maumere Alor Derawan, Maratua, Sangalaki Ambon, Banda Makassar, Pangkep, Bira Selayar, Takabonerate Donggala Togian Gorontalo Manado, Bunaken, Gangga, Bangka, Sangihe, Lembeh, Buyat Maluku Utara, Morotai, Halmahera Barat, Halmahera Timur, Ternate Raja Ampat Teluk Cendrawasih, Biak, Manokwari, Padaido, Nabire Other Indonesia Kendari, Buton, Wakatobi
In Operation Since (Year)*:
Company Status*: PT CV Koperasi Club PMA Other
Physical Address (in Indonesia)*:
City:
State:
Phone no*:
Fax no:
Mobile phone no:
Satellite phone no:
Website:
Email Address*:

Position*: Manager Director Owner
Name*:
Address*:
City:
State:
Phone no*:
Fax no:
Mobile phone no:
Email Address*:

Are you a Land-based operator? Yes No
Are you a Liveaboard operator? Yes No
Do you provide regular dive trips? No Daily Weekly Monthly Seasonal
Do you have certified Dive Leader(s) to supervise all your dive trips? Yes No
Do you provide dive courses? Yes No
What agency? BSAC   CMAS - POSSI   IANTD   NAUI   PADI   SSI   TDI/SDI   Other(s)  
Other(s)
Do you have renewed and certified Dive Instructor(s) qualified to teach the course(s)? Yes No
Do you provide Nitrox? Yes No
Do you provide technical diving? Yes No
Do you provide equipment rental? Yes No
Do you provide underwater camera rental? Yes No
Do you provide disabled diver services? Yes No
Do you provide shore dives? Yes No
Do you provide boat dives? Yes No
How many boats you own?
Do you provide underwater photography courses? Yes No
Do you provide diving insurance? Yes No
Do you provide travel/accommodation arrangements? Yes No
Do you have immediate access to emergency oxygen during your diving activities? Yes No
Do you have first aid kits at your facility and/or onboard your boat(s)? Yes No
Do you provide services to guests who speak languages other than Bahasa Indonesia and English?

I declare that the information submitted is correct and I am acting as the legal representative of this dive centre/operator. Any error(s) in the information submitted will be my full responsibility.

The IWUPC committee reserves the right to review, verify, and approve the participation of the dive operator and has the right to reject or accept participation without explanation.

By submitting this Registration Form, I declare that I have read and understood and agree to abide by the Rules and Regulations of the IWUPC 2013.