APPLICATION FORM

PERSONAL DATA

NAMA : ASWAR SANGGE

PLACE & DATE OF BIRTH : SEPPONG, 25 FEB 1989
RELIGION : MOESLEM
NATIONALITY : INDONESIAN
ADDRESS : MAKASSAR
MOBILE NO. : 081343613194

TRAVEL DOCUMENT

DOCUMENT NAME NO PLACE & DATE OF ISSUED DATE OF EXPIRY

PASSPORT A 7993872 MAKASSAR, 10 JUNI 2014 10 JUNI 2019
SEAMAN BOOK W. 050836 MAKASSAR, 11 JUNI 2014 29 JUNI 2016

CERTIFICATE OF COMPETENCY

CERTIFICATE NAME NO PLACE & DATE OF ISSUED

NAVIGATION WACTH KEEPING ANT-D 6200565689N60610 JAKARTA, 05 MARET 2010
DECK OFFICER CLASS ANT-V 6200565689N50614 JAKARTA, 25 APRIL 2014
ENDORSEMENT ANT-V 6200565689NE0614 JAKARTA, 5 MEI 2014

CERTIFICATE OF FROFICIENCY

CERTIFICATE NAME NO PLACE & DATE OF ISSUED

BASIC SAFETY TRANING (BST) 6200565689010609 MAKASSAR, 12 JUNI 2009
SEMENTARA DALAM PROSES REVALIDASI
SURVIVAL CARFT & RESCUE BOAT (SCRB) 6200565689040609 MAKASSAR, 03 JULY 2009
SEMENTARA DALAM PROSES REVALIDASI
ADVANCED FIRE FIGHTING (AFF) 6200565689060613 MAKASSAR, 10 DESEMBER 2013
MEDICAL FIRST AID (MEFA) 6200565689070613 MAKASSAR, 13 DESEMBER 2013
RADAR SIMULATOR 6200565689030613 MAKASSAR, 19 DESEMBER 2013
BRIDGE RESEOURCE MANGEMENT (BRM) DALAM PROSES
ARPA SIMULATOR DALAM PROSES
SHIP SECURITY OFFICER (SSO) DALAM PROSES
RESTRICTED OPERATOR CERTIFICATE (ROC) 6200565689250613 MAKASSAR, 30 NOVEMBER 2013

SEA SERVICES RECORD

NAME OF VESSEL TYPE RANK GRT & CONTRACT & TRANDING COMPANY NAME &
HP AREA REGISTER
KM. TRI TUNGGAL CARGO AB 1025 gt 12, NOV,2007 – 29, OCT, 2008 PT. INTAN SAMUDERA
SHIP 870 hp (1 years) at Indonesian Indonesia
TB. MARCOPOLO 57 TOWING COOK 159 gt 22, MEI, 2010 – 23, OCT, 2010 PT. SINAR GRATIA NUS
BOAT 1200 hp (05 month) at Indonesian Indonesia
MV. EBS UTILITY AB 454 gt 23, OCT, 2010 – 28, DES, 2011 PT. SINAR GRATIA NUS
MARCOPOLO 69 VESSEL 2500 hp (15 month) at Natuna oil field Indonesia

Sincerely yours,

ASWAR SANGGE