Place,date of birth : NGANJUK, 2 Maret 1998 Address : Lingk.Gambirejo Rt.3/Rw.1 Kec. Tanjunganom Kab. Nganjuk Jawa Timur Religion : Moeslem Status : Single Mobile phone : 081296122862
II. SEAFARER’S IDENTIFY DOCUMENT
NO DESCRIPTION DOCUMENT NUMBER DATE OF ISSUED DATE OF EXPIRE
1 SEAMAN’S BOOK E 119593 14 NOVEMBER 2019 14 NOVEMBER 2021 2 MCU 6211605746MC3019 28 DESEMBER 2018 28 DESEMBER 2020
III. CERTIFICATE OF PROFIENCY
NO TYPE OF CERTIFICATE CERTIFICATE NO PLACE ISSUE DATE
1 BST 6211605746310517 Surabaya, 11 Oktober 2016 2 SAT 6211605746310517 Surabaya, 01 Maret 2017 3 AFF 6211605746060517 Surabaya, 28 Februari 2017 4 RATING DECK 6211605746330517 Surabaya, 20 Juni 2017 5 RATING AS ABLE SEAFARER DECK 6211605746340519 Surabaya, 29 Maret 2019
IV. ACTIVE SEA SERVICE
NO SHIP NAME RANK GT SIGN ON SIGN OFF COMPANY
01-06- PT. BINTANINDO 1 KM WIRAS PERMATA 01 JURU MUDI 947 GT 11-12-2017 2017 SENTOSADAYA 27-12- PT. BINTANINDO 2 KM WIRAS PERMATA 01 JURU MUDI 947 GT 13-04-2018 2017 SENTOSADAYA SPOB BHAKTI SATRIA 07 16-04- 3 JURU MUDI 342 GT 30-01-2019 PT. PRIMANRU JAYA UTAMA 2018