Full Name : UDIN SAMSUDIN Sex : Male

Place & Date of Birth : 02 April 1971 Religion : Islam

Nationality : Indonesia Marital Status : Married
Heigh : 65 cm Weight : 75 Kg Blood Type : A
Safety Shoes Size : 41
Photo
Temporary Address : Asrama Yon Ang Air Ananta 1 Semper-Jakarta Utara
HP : 085221944175
Contact Telp : 0812821265961
Permanent Address : Tenjo Laut RT.08/03 Jalupang-Subang
Contact Telp : 081365210681

DOCUMENTS
Document Number Place of Issue Date of Issue Date of Expire
Passport N.173468 Jakarta 23 Januari 2004 23 Januari 2009
Seaman Book V.005278 Jakarta 17 Desember 2007 16 Desember 2010

CERTIFICATE OF COMPETENCY
Certificate Number Place & Date of Issue Date of Expire

ANTD 6200040038 N 601011 Jakarta 23 Januari 2004

Endorsement Number Place & Date of Issue Date of Expire

CERTIFICATE OF PROFICIENCY
Certificates Number Place of Issue Date of Issue Remark
Basic Safety Training 6200040038010103 Jakarta 23 July 2012 Unlimited
Survival Craft & Rescue Boat 6200040038010103 Jakarta 23 July 2012 Unlimited
Tanker Familiarzation 6200040038010103 Jakarta 23 July 2012 Unlimited
Oil Tanker 6200040038010103 Jakarta 23 July 2012 Unlimited
Advanced Fire Fighting 6200040038060112 Jakarta 13 August 2012

RECORD OF SEA SERVICE

Name of Type of Vessel GRT/DWT Period Company/Agen
Rank
Vessel Type of Engine HP/KW Sign On Sign Of t

MT. Pan Glory Mase Boy Tanker / 2500 3437 15,02,91 27,11,91 IMM
Yanmar
TB. Searly Jaya OS Tuck Boat 04,06,92 03,11,92
Yanmar
MT. Pan Glory OS Tanker / 2500 3437 03,11,02 24,05,93 IMM
Yanmar
MT. Tirta Karsa Bosun Tanker / 2500 1306 24,05,93 01,04,96 TCK
Hanjin
MT. Tirta Gama Bosun Tanker / 2500 1302 10,09,98 06,01,99 TCK
Hanjin
MT. Pamuradan Bosun Tanker / 1500 1502 29,03,99 01,05,02 TCK
Tanmar
MT. Filma A/B Tanker / 7500 4020 01,05,02 19,05,04 TCK
Hanjin
MT. P.Halaban A/B Tanker / 10000 5035 19,05,04 03,02,07 TCK
Hanjin
MT. P. Mas A/B Tanker / 5000 2694 23,03,07 03,07,09 TCK
Wartsila 2053
MT. Christine VIII A/B Tanker 1852 03,12,09 18,04,12 ABPL
Hanjin

Date : 17/09/2012
Signature of Applicant :

( UDIN SAMSUDIN )