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PERSONAL DATA

Name :
Place & Date of Birth :
Address :
Marital Status :
Nationality :
Religion :
Telephone / Mobile :

DOCUMENT
Name of Document Number Issued Date Expire Date Issuing Authority
Passport P 1234569 Jan, 16th 2017 Jan, 16th 2022 Semarang
Seaman’s Book P 123456 Oct, 19th 2017 Oct, 18th 2022 Teluk Bayur

CERTIFICATE OF PROFICIENCY

Type of Certificate Certificate Number Place / Date of Issued


Basic Safety Training (BST) 6200251270010844 Semarang, Feb 14th 2007
AFF 6200251270040844 Semarang, Feb 19th 2007
SAT 6200251270059844 Semarang, Feb 26th 2007

Sign On Sign Of
For detail certificate of competency (COC) and certificate of proficiency (COP ), please click
www.pelaut.go.id
Yours Faithfully
If any vacancy for me,
Please contact me by phone
No: +6281225151739

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