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    Seaman book Medical check up Seafarer's identify document document number X 028521 A 201210 / MCUIS / XI / II Place, date of issued Surabaya, 25 March 2010 Surbaya, 09 November 2011 Expired date 24 March 2013 09 November 2013 Certificate of competency Certificate number 6201506998N60511 Place, date issued Jakarta, 22 July 2011 IV.

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    Seaman book Medical check up Seafarer's identify document document number X 028521 A 201210 / MCUIS / XI / II Place, date of issued Surabaya, 25 March 2010 Surbaya, 09 November 2011 Expired date 24 March 2013 09 November 2013 Certificate of competency Certificate number 6201506998N60511 Place, date issued Jakarta, 22 July 2011 IV.

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    2 views2 pages

    Personal Data

    Uploaded by

    cantrek
    Seaman book Medical check up Seafarer's identify document document number X 028521 A 201210 / MCUIS / XI / II Place, date of issued Surabaya, 25 March 2010 Surbaya, 09 November 2011 Expired date 24 March 2013 09 November 2013 Certificate of competency Certificate number 6201506998N60511 Place, date issued Jakarta, 22 July 2011 IV.

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    I.

    Personal data

    Name

    : Taufik Asror : Lamongan 07 Januari 1984 : Male : Single : Indonesia : Islam : 165 cm/ 50 Kg : Sungelebak, Karang Geneng, Lamongan : +6282140258220/08563348254

    Place, date of birth Gender Marital Status Nationality Religion Height/Weight Address Contact Person

    II. Description Seaman book Medical check up

    Seafarers identify document Document number X 028521 A 201210/MCUIS/XI/II Place, date of issued Surabaya, 25 March 2010 Surbaya, 09 November 2011 Expired date 24 March 2013 09 November 2013

    III. Certificate ANT-D

    Certificate of competency Certificate number 6201506998N60511 Place, date of issued Jakarta, 22 July 2011

    IV.

    Certificate of proficiency Certificate number 6201506998010510 Place, date of issued Surabaya, 15 February 2010

    Certificate Basic Safety Training (BST)

    V. Vessel Name KM. MANGKAJANG PERMAI KMP. PANORAMA NUSANTARA

    Sea service record Company PT. Samudra Alam Raya PT. PRIMA EKSEKUTIF Rank Koki 8915/2x6500 PELAYAN 05.01.2010/26.05.2012 Gt/hp 116/746 Periode of service 10.05.2010/14.11.2011

    Vessel type CARGO RO-RO

    Sincerely Yours, (TAUFIK ASROR)

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