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Position GRT/BHP Flag
Engine Cadet 61619 / 21140BHP Indonesia 6-Apr-16
on progress
D. MARITIME LICENSE
Security Awareness Training
Description
6211551271400110
6211551271410118
6211551271060115
6211551271390115
Medical Care
U.S Visa
Date of issue
14.10.2015
Weight
Size of working cloth
Imediately
170 cm
Advanced Tanker Safety - Gas
Tanker Familiarization
6211551271240118
6211551271270217
Medical First Aid Training
Advanced Fire Fighting
Engine Resource Management
Ship Security Officer (SSO)
18.12.2017
09.02.2023
18.12.2022
27.12.2022
01.02.2018 01.02.2023
27.12.2017
09.02.2018
27.10.2015
C. COURSES
41
02.11.2015
Basic Safety Training
Survival Craft Rescue Boat
09.11.2020
02.11.2020
14.10.2020
6211551271310115
6211551271040118
22.10.2020
Issued by
Validation
6211551271070115
09.02.2023
27.10.2020
22.01.2023
6211551271010115
Christian
Binjai Street, North of Sumatera - Indonesia
Date of expiry
B2963564
07.01.2016
07.01.2021
Engine Cadet
M
Name
Date of Birth & Place
Nationality
Religion
************@*****.**.**
Address
Telephone number
Bintang Lard Togu Sinaga
27/08/1993 Purwodadi
Indonesian
Alternative
Date of Availability
Weight
Description Number Date of issue
Position applied
Rini MZ Sinaga
09.02.2018
Certificate No.
Passport
11.05.2018
Advanced Tanker Safety - Oil
Advanced Tanker Safety - Chemical
Management
Soechi Lines
Endorsement
Engineer Officer Class III
Mt Fortune Villa XLIII 9138604 8-May-17
on progress
Type Certificate No. Date of issue
Marital Status
Flag State License
Single
E. SEA SERVICE RECORD
Vessel IMO type Period
6211551271080217
11.05.2021
22.10.2015
22.01.2018
09.11.2015
Number of children
Next of Kin (NOK)
Address
Telephone number
Seaman's Book
Binjai Street, North of Sumatera - Indonesia
Size of Shoes
70 kg
APPLICATION FORM
A. PERSONAL
E019399
B. PERSONAL DOCUMENT
Date Expiry Date Taken
18/03/2018 17/03/2016
18/03/2018
18/03/2018
18/03/2018
18/03/2018
17/03/2026
Date Expiry
Typhoid
18/03/2016
18/03/2016
Applicant / Signature
Medical
Test Drugs
Form
Simple
MCIS
Date,
18/03/2016
Extensive
Date Taken
18/03/2016
18/03/2016
F. MEDICAL RECORD
Last Medical Check Up:
Yellow Fever
Cholera
Vaccination