PRE ASSIGNMENT DOCUMENTATION CHECKLIST AND RECORD

(Copies of all documents must be preserved in candidate's Profile) Synergy Maritime Recruitment Services Pvt. Ltd.
(For new recruit - This form needs to be filled out for a candidate who has been found suitable for interview)
For Existing crew - This form needs to be filled 60 days before being planned to vessel)
Name DIDIE NURIA HASRIYANTO Rank 3RD ENGINEER Crew Code 6202115962
Place of Date of
S.No Types of Documents Number Date of Expiry
Issue Issue
1 National Passport B 8299117 JAKARTA 19 OCT 2017 19 OCT 2022
2 National CDC & Authentication
MANDATORY FOR ALL RANKS

3 National COC / COP * & Authentication 6202115962T20519 JAKARTA 17 Sep 2019 UNLIMITED
4 EFA / MFA / Medicare* 6202115962070318 SEMARANG 05 OCT 2018 05 OCT 2023
5 PST 6202115962010316 SEMARANG 17 OCT 2016 17 OCT 2021
6 FPFF / AFF* 6202115962060318 SEMARANG 09 OCT 2018 09 OCT 2023
7 PSSR
8 PSCRB 6202115962040318 SEMARANG 09 OCT 2018 09 OCT 2023
9 Yellow Fever EOO-124611 JAKARTA 21 OCT 2020 UNLIMITED
10 MUI / NUSI / Union Membership Card*
11 INDoS No
12 National GMDSS & Authentication
13 National GMDSS Endorsement
14 Radar Simulator / Ransco
DECK OFFICERS

15 Radar Observer / ARPA

16 BTM Course
17 SSO - Master & CO
18 Ship Manoeuvering Simulator - Master
19 ECDIS - Generic
20 HAZMAT - Container *
21 ERM Course SEMARANG 03 OCT 2016 03 OCT 2021
OFFIC

6202115962270316
ENG

ERS

22 SSO /STSDSD* 6202115962320318 SEMARANG 09 OCT 2018 09 OCT 2023

23 CoC / CoP* Endorsement. Grade / Rank………..
24 SIRB / CDC
FLAG

25 Endorsement of SSO/STSDSD
26 Endorsement of GMDSS
Endorsement of DCE (Oil/ Chem / Gas*)
27
Mgmt. /Ops*
Advanced Oil/ Chemical / Gas*
OIL/CHEM /GAS*

28 6202115962380316 JAKARTA 18 Nov 2016 18 Nov 2021

(All officers and Engineers)
Basic Training Oil / Chemical / Gas*
29 (All Rating, Cadets & Trainees)
6202115962370316 SEMARANG 22 Nov 2016 22 Nov 2021

30 LCHS Course - Ops/ Mgmt. *

31 National DCE (Oil/ Chem /Gas*) Mgmt./Ops*
32 ECDIS - Type Specific
33 Refresher Course (RUT)
OTHERS

34 Officer Safety Training (in house)

35 BTM Course - Deck Officer (in house)
36 VGP (US Calling vsls)
Training needs identified Names of Courses
TRAININS NEEDS

a) As per matrix (OF-MA-013)

b) As per appraisals
c) As per interview remarks (M03) (M05)
d) as per requirement towards promotion
e) as per new legislation indroduced
* Delete as applicable. Number of days for familiarization

Seafarers DG profile is up to date and confirmed with Seafarer Yes / No

Checked by Office Executive (Name) Date Signature

Ed 01 Rev No 0
Form M 03 Page 1 Date:10-Jan-2020