I.

PERSONAL DATA
Name : SUSILO NUGROHO
Place & Date of Birth : Brebes, 19 July 1990
Addres : Desa Sigentong Rt.003/003
Kec. Wanasari Kab. Brebes Jawa Tengah
Status : Single
Religion : Moslem Sex
Male Telephone : 082110120048
E-mail : Silo.wonarky@gmail.co m

II. PERSONAL DOCUMENT

NO TYPE NUMBER EXPIRE DATE PLACE OF ISSUED
1 Seament Book F333277 26 Juni 2023 Tegal
2 Pasport B3320575 03 Maret 2021 Pemalang

III. CERTIFICATE OF COMPETENCY

NO CERTIFICATE TYPE CERTIVICATE PLACE & DATE OFF
NUMBER ISSUED
1 Rating Forming Part Of a Watch 6201291993350716 Jakarta,23 Januari 2016
in Engine Room
2 Rating as Able Seafarer Engine 6201291993420217 Jakarta,11 Desember 2020

IV. CERTIFICATE OF PROFICIENCY

NO CERTIFICATE TYPE CERTIVICATE PLACE & DATE OFF
NUMBER ISSUED
1 Basic Safety Traning (Revalidasi) 6201291993010315 Semarang,24 Juni 2020
2 Security Awareness Training 6201291993310515 Surabaya,02 Okt 2015
3 Advanced Fire Fighting 6201291993060515 Surabaya,23 Okt 2015
4 Seafarers With Designated 6201291993320716 Jakarta,24 Feb 2016
5 Proficiency in Survival Craft and 6201291993040716 Jakarta,18 Feb 2016
Rescue Boats
6 Medical First Aid 6201291993070718 Jakarta,10 Maret 2018

V. SEA WORKING EXPERINCE

NAME OF TYPE RANK GRT/HP COMPANY/ PERIODE
VESSEL OF FLAG Sign On Sign Off
VESSEL
KM. DELTA CARGO OILER 892/1470 PT.LAUT 12.12.2014 04.04.2015
SEMBADA KUMALA
KM. DELTA CARGO WIPER PT.LAUT 30.04.2015
SEMBADA 892/1470 KUMALA 04.04.2015
KM. DELTA CARGO OILER 892/1470 PT.LAUT 30.04.2015 12.09.2015
SEMBADA KUMALA
KM. CARGO OILER 3208/2 PT.MANDIRI 01.02.2016 30.08.2016
SAHABAT SEJAHTERA
SEJATI 8 ABADI LINE
KM. CARGO OILER 2646X29 PT.Lintas 06.09.2016 06.10.2017
BAHARI 6 78 KW Bahari
Nusantara
ADINDA LCT OILER 1719/2x7 PT.Alfa Trans 21.04.2018 09.01.2019
CELINA 46 kw Raya
Mv. CARGO OILER 1653X21 PT.Alfa Trans 12.04.2019 02.07.2019
ADINDA 520 KW Raya
IZORA
ADINDA LCT OILER 1668 MT PT.Alfa Trans 05.07.2019 20.03.2020
DIZA Raya
MV. BULK OILER 25227/11 PT. Gurita 01.11.2020 21.05.2021
ARFIANIE CARRIE 520PS Lintas Samudra
MV. KAYSAN R
BULK OILER 30738/12 PT. Gurita 07.06.2021 13.10.2021
CARRIE 870PS Lintas Samudra
R Your Faitfully

SUSILO NUGROHO