SEAFARER'S APPLICATION FORM

Position: RATING Citizenship: Indonesia

Last name: Saputra Marital status Single
First name: Tri Children: -
Middle name: Junaedi Nationality: Indonesian
Birth date: 29.06.1995 Birth place: Jakarta
Home address: Phone mobile: +6281285673793
Jl.Sindang no.36 RT.006 RW.009 Koja Phone home: -
Jakarta Utara 14210 Email: pustakajun@gmail.com.com
English level: Grade-B

Passports, Licenses & Certificates

Title Class Number Issued by Issued Valid
Passports & Visas
Seaman's book H 065493 Kantor 12 Agustus 2022 12 Agustus 2025
Kesyahbandaran
Utama Tanjung
Priok
Certificates & Licenses
Ratings Forming Part Of A Navigation (Deck) 6211428563330222 BP3IP Jakarta 13 September 2022 13 September 2027
Basic Safety Training (BST) 6211428563010122 STIP Jakarta 20 JUNE 2022 20 JUNE 2027
Advanced Fire Fighting (AFF) 6211428563010122 STIP Jakarta 22 JUNE 2022 22 JUNE 2027
Medical First Aid (MFA) 6211428563070122 STIP Jakarta 31 Agustus 2022 Unlimited
Proficiency in Survival Craft (SCRB) 6211428563040122 STIP Jakarta 06 September 2022 06 September 2027
Security Awareness Training (SAT) 6211428563310116 STIP Jakarta 06 September 2022 Unlimited
Designated Security Duties (SDSD) 6211428563320116 STIP Jakarta 8 September 2022 Unlimited

Sea-going experience
Vessel’s Flag Call Type Tonnage From Shipowner
Rank
Name Year Sign DWT Till Crew
Agency
05.12.2014
KM. TIRTA SAMUDERA Oil Products Pt. Usda Seroja
1 ID NCV 2223 Kelasi 17.04.2016
XXV Tanker Jaya
17.04.2016
21.01.2021
2 MV. GOLDEN REJEKI ID NCV Bulk Carrier 30006 Kelasi Pt. Ocean Line
25.05.2022

25.05.2022

General Physical State

Height (cm) Weight (kg) Shoes Clothes Hair color Eye color

169 67 40 L Black Brown

1 TRI JUNAEDI SAPUTRA