DAMAR LINTAS BUANA CO.

LTD
INTERNATIONAL CREWING AGENCY
Company Reg. No. : AHU-0047130.AH.01.01

APPLICATION FORM

Last Name/Surname First Name

Position Applied for
Date of Birth
Place of Birth
Nationality
Religion PHOTOS
Gender
Height Overall Size
Weight Shoe Size (EU)
Marital Status
Mobile Phone

DOCUMENT DETAILS
Detail of Document Number Date of Issue Date of Expiry

CERTIFICATE OF COMPETENCY
Name of Certificate Number Place of Issue Date of Issue Date of Expiry

Main Office: Mawar Dalam Barat 48 Lagoa, Koja, North Jakarta 14230
Phone: +6282111100245 / +6281226111595 Website: damarlintasbuana.com
 DAMAR LINTAS BUANA CO. LTD
INTERNATIONAL CREWING AGENCY
Company Reg. No. : AHU-0047130.AH.01.01

CERTIFICATE OF PROFICIENCY
Name of Certificate Number Place of Issue Date of Issue

SEA SERVICE EXPERIENCES

Rank Company Name of Vessel’ Vessel’s GRT Engine/KW From To
Vessel s Type Flag

Main Office: Mawar Dalam Barat 48 Lagoa, Koja, North Jakarta 14230
Phone: +6282111100245 / +6281226111595 Website: damarlintasbuana.com