SEMEN’S RECORD APPLICATION FORM

CREW’S PARTICULAR
Full Nama : IBNU HAJAR
Rank : AB (Engine)
Marital Status : Married
Place & Date Of Birth : Palembang, 24 Juni 1985
Nationality : Indonesia
Address : Jl. PSI Kenayan RT.007 RW.003 Kel. Karang Anyar, Palembang
Telephon / Mobile : +62895406680205
Email : sjuanda774@gmail.com

TRAVELLIN DOCUMENT

NO. Ducument Number Expire Date Issued At Date Of Issue

01. Seaman Book C 046370 10 Jan 2016 Cirebon 11 Jan 2013

CERTIFICATE OF COMPETENCY
NO Document Serial No. Place & Date Of Issued
01. Ratting As Able Seafarer Engine 6201194186350715 Jakarta, 03 Juli 2015

CERTIFICATE OF PROFICIENCY
Course Title Certificate No. Issued Year Issued At

01. Basic Safety Training 6201194186010110 09 Juni 2010 / 2016 Jakarta

02. Advance Fire Fighting 6201194186060114 07 Juli 2014 Jakarta
04. Proficiency In Survival Craft And Rescue Boats 6201194186040114 25 Agustus 2014 Jakarta
07. Security Awareness Training 6201194186314115 20 Febuari 2015 Jakarta

SEA SERVICE RECORDS AS RECORDS IN SEAMEN’S BOOK

NO. Vessel Name Type GRT Rank From Until Flag
01. KM. SINAR NUSANTARA CARGO 670 Wiper 18.01.2013 22.02.2014 NVC
02. KM. BINTANG NATUNA CARGO 1345 Oiler 24.08.2015 18.10.2015 NVC
03. KM. SAHABAT SEJATI 8 CARGO 3208 Oiler 19.03.2015 03.06.2015 NVC
04. KM. BERLIAN INDAH CARGO 2864 Oiler 13.10.2015 30.07.2016 NVC
05 KM. LINTAS HARUAN KONTENER 2003 Oiler 30.07.2016 07.05.2017 NVC

Palembang, / 2019
IBNU HAJAR