LIR RESPATI BUMIDAYA
M.V. “ (INTENTIONALY LEFT BLANK) “
CREW’S PERSONAL PARTICULARS
|
1.
|
NAME
|
SUGIYARTO
|
||||||||
|
|
||||||||||
|
2.
|
RANK
|
CHIEF OFFICER
|
||||||||
|
|
||||||||||
|
3.
|
MARITAL STATUS
|
MARRIED
|
NATIONALITY
|
INDONESIA
|
||||||
|
|
||||||||||
|
4.
|
PASSPORT NO.
|
U 543643
|
PLACE OF ISSUE
|
JAKARTA, TG. PRIOK
|
||||||
|
|
||||||||||
|
|
DATE OF ISSUE
|
03-02-2010
|
VALIDITY DATE
|
03-02-2015
|
||||||
|
|
||||||||||
|
5.
|
SEAMAN BOOK NO.
|
Y 041382
|
PLACE OF ISSUE
|
JAKARTA, TG. PRIOK
|
||||||
|
|
||||||||||
|
|
DATE OF ISSUE
|
28-04-2011
|
VALIDITY DATE
|
28-04-2014
|
||||||
|
|
||||||||||
|
6.
|
DATE OF BIRTH
|
23-03-1984
|
PLACE OF BIRTH
|
SUKOHARJO
|
||||||
|
|
||||||||||
|
7.
|
ADDRESS
|
PERUM. TRUNUH INDAH
B 09, KLATEN SELATAN, KLATEN, JATENG.
|
||||||||
|
|
||||||||||
|
|
|
|||||||||
|
|
||||||||||
|
8.
|
EDUCATION
|
PIP SEMARANG / ANT II
|
||||||||
|
|
||||||||||
|
9.
|
CERTIFICATEOF
COMPETENCY AND OTHERS
|
|||||||||
|
|
||||||||||
|
|
(A)
|
CERTIFICATE OF COMPETENCY AS ANT
II
|
6200406503N20310 |
|||||||
|
|
||||||||||
|
|
(B)
|
STCW CERT. OF ENDORSEMENT 6200406503NB0310
|
||||||||
|
|
||||||||||
|
|
(C)
|
GENERAL OPERATOR’S
CERT. REVALIDATION PROCESS
|
||||||||
|
|
||||||||||
|
|
(D)
|
SHIP SECURITY
OFFICER. REVALIDATION PROCESS
|
||||||||
|
|
||||||||||
|
|
(E)
|
BST / PSSR NO.:
6200406503010309
|
||||||||
|
|
||||||||||
|
|
(F)
|
PROF IN SURV CRAFT
& RESCUE BOAT NO.:6200406503040309
|
||||||||
|
|
||||||||||
|
|
(G)
|
MEDICAL FIRST AID
(MEFA) NO.:6200406503070309
|
||||||||
|
|
||||||||||
|
|
(H)
|
ADVANCED FIRE
FIGHTING (AFF) NO.:6200406503060309
|
||||||||
|
|
||||||||||
|
10.
|
CONTACT TELEPHONE NUMBER (INCLUDING
COUNTRY/AREA CODE)
|
(+62)81219391547
/ (+62)8568466879
|
||||||||
|
|
||||||||||
|
11.
|
WAGES PER MONTH
|
(INTENTIONALY
LEFT BLANK)
|
||||||||
|
|
||||||||||
|
12.
|
DATE ENGAGEMENT
|
(INTENTIONALY LEFT
BLANK)
|
||||||||
|
|
||||||||||
|
13.
|
JOINING PORT
|
(INTENTIONALY LEFT
BLANK)
|
||||||||
|
|
||||||||||
|
14.
|
PLACE OF
REPATRIATION AFTER FINISHING OF CONTRACT
|
|
||||||||
|
|
||||||||||
|
15.
|
ALLOTMENT (
ALLOTTEE NAME & BANK ACCOUNT NO.)
|
(INTENTIONALY LEFT BLANK)
|
||||||||
|
|
|
|||||||||
|
|
|
|||||||||
M.V. “ (INTENTIONALY LEFT BLANK) “
NEXT-OF-KIN
|
16.
|
NAME
|
CITRA DEWI
AGUSLIANA
|
||||||||||||
|
|
||||||||||||||
|
17.
|
RELATIONSHIP TO
CREW
|
WIFE
|
||||||||||||
|
|
||||||||||||||
|
18.
|
ADDRESS
|
KLATEN, JATENG,
INDONESIA
|
||||||||||||
|
|
||||||||||||||
|
19.
|
CONTACT TELEPHONE NO.
(INCLUDING COUNTRY/AREA
CODE)
|
HOME
|
|
CELLPHONE/OTHERS
|
(+62) 85726843743
|
|||||||||
|
|
||||||||||||||
|
20.
|
FATHER’S NAME
|
YATMO REJO
|
||||||||||||
|
|
||||||||||||||
|
|
||||||||||||||
|
|
||||||||||||||
TO WHOM IT MAY CONCERN |
||||||||||||||
|
|
||||||||||||||
|
|
||||||||||||||
FAMILY DETAILS – CHILDREN |
||||||||||||||
|
|
||||||||||||||
|
NO.
|
|
NAME
|
|
SEX
|
|
DATE OF BIRTH
|
|
PLACE OF BIRTH
|
||||||
|
|
||||||||||||||
|
1.
|
|
SUGIYARTO
|
|
M
|
|
23-03-1984
|
|
SUKOHARJO
|
||||||
|
|
||||||||||||||
|
2.
|
|
CITRA DEWI AGUSLIANA
|
|
F
|
|
20-08-1987
|
|
PATI
|
||||||
|
|
||||||||||||||
|
3.
|
|
RADITHYA ADKHA BRAMANTY
|
|
M
|
|
08-11-2011
|
|
PATI
|
||||||
|
`
|
||||||||||||||
|
4.
|
|
|
|
|
|
|
|
|
||||||
|
|
||||||||||||||
|
5.
|
|
|
|
|
|
|
|
|
||||||
|
|
||||||||||||||
|
|
||||||||||||||
|
DETAILS
OF SEA-GOING EXPERIENCE (IN CHRONOLOGICAL ORDER)
|
||||||||||||||
MASTER
NATIONALITY
|
NAME
OF VESSEL
|
RANK
|
SIGNED |
NO.
OF MONTHS
|
CAUSE
OF DISCHARGE
|
VESSEL TYPE |
GRT
|
ENGINE
MAKE
|
BHP
|
PRINCIPAL/
OWNER
|
VESSEL
FLAG
|
DESCRIPTION
OF WORKS/EXPERIENCE
|
||
|
ON
|
OFF
|
|||||||||||||
|
HINDIA
|
MV. CARAKA 23
|
CADET
|
16.10.2004
|
27.11.2005
|
12 M
|
FINISH CONTRACT
|
CONTAINER
|
3256
|
|
|
SAMUDERA INDONESIA
|
INDONESIA
|
CONTAINER CARRIAGE
|
|
|
INDONESIA
|
TB.PATRA TUNDA
|
2/O
|
21.05.2007
|
29.01.2008
|
8
M
|
FINISH CONTRACT
|
TB, HT
|
413 GT
|
|
4200 KW
|
PERTAMINA TONGKANG
|
INDONESIA
|
ASSIST SBM, AHT, TOWING, HARBOUR TUG.
|
|
|
INDONESIA
|
SV. PETROGAS SUPPY O3
|
2/O
|
06.03.2008
|
31.08.2008
|
5
M
|
FINISH CONTRACT
|
AHT, SV
|
539 GT
|
|
2800 KW
|
PERTAMINA TONGKANG
|
INDONESIA
|
ANCHOR HANDLING, RUNNING CARGO
|
|
|
INDONESIA
|
TB.PATRA TUNDA
|
2/O
|
11.09.2008
|
30.12.2008
|
3
M
|
FINISH CONTRACT
|
TB, HT
|
413 GT
|
|
4200 KW
|
PERTAMINA TONGKANG
|
INDONESIA
|
ASSIST SBM, AHT, TOWING, HARBOUR TUG.
|
|
|
PHILIPINA, INDONESIA
|
SV. PETEKA 5401
|
2/0
|
14.01.2009
|
17.06.2009
|
5
M
|
FINISH CONTRACT
|
AHTS
|
1319 GT
|
|
5400 KW
|
PERTAMINA TONGKANG
|
INDONESIA
|
ANCHOR MANDLING, TOWING BARGE&RIG, RUNNING CARGO.
|
|
|
INDONESIA
|
SV. PERMINA SUPPLY 33
|
1/O
|
28.12.2009
|
21.05.2010
|
5
M
|
FINISH CONTRACT
|
SV
|
1135 GT
|
|
4476 KW
|
PERTAMINA TONGKANG
|
INDONESIA
|
RUNNING CARGO, ASSIST DIVER FOR PIPING INSTALATION.
|
|
|
INDONESIA
|
SV. PETROGAS SUPPY O1
|
1/O
|
19.07.2010
|
04.02.2011
|
8
M
|
FINISH CONTRACT
|
AHT, SV
|
539 GT
|
|
2800 KW
|
PERTAMINA TONGKANG
|
INDONESIA
|
ANCHOR HANDLING, RUNNING CARGO
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Name: SUGIYARTO
Signature:
Tidak ada komentar:
Posting Komentar