SEAMAN'S RECORD

1. PERSONAL DETAILS
Position :
2ND/OFF Name of Ship :
Name RENTA FEDLIN
Place / Date Of Birth BULU KURING, 18 JANUARY 1989
Gender MALE
Age 28 AGE PHOTO
Height 168 CM
Weight 62KG
Uniform Size L
Shoes Size 265MM
Blood Classify
Marital Status SINGLE
Health GOOD
Nationality INDONESIA
Religion ISLAM
Home Phone No. / Mobile
Address PERUM BUKIT AZZIKRA BLOK IKHLAS II RT 002/003 CIPAMBUAN BOGOR WEST JAVA
2. CERTIFICATE'S OF COMPETENCY ( C.O.C )
C.O.C Number Expire Remark
Issue
Deck Officer Class III MANAGEMENT 6200266950N30115 15-Jan-15 UNLIMITED
Endorsement Management 6200266950NC0115 15-Jan-15 15-Jan-20
G.O.C 24516/SOU/1/2012 3-Jun-12 3-Jun-17
Others
3. TRAVEL DOCUMENTS
Type Number Date of Issue Date of Expiry

Passport B 2402025 NOV 17TH, 2015 NOV 17TH, 2020

Seaman book E 032856 NOV 10TH, 2015 NOV 06TH, 2018
4. CERTIFICATE OF PROFECIENCIES,STCW'95 ( Solas / Marpol / Tanker's / Other's )
Item's Number Date of Issue Date of Expiry Remark

Basic Safety Training (B.S.T) 6200266950010115 AUG 31TH, 2015

PSC Rescue Boat (S.C.R.B) 6200266950040115 AUG 31TH, 2015
Advanced Fire Fighting 6200266950060115 AUG 31TH, 2015
Medical First Aid (M.F.A) 6200266950071117 FEB 03TH, 2012
Medical Care On Board Ship 6200266950081117 FEB 05TH, 2012
Bridge Room Resource Mana 6200266950230215 NOV 11TH, 2015
Profiency GMDSS 62002669502G1117 FEB 09TH, 2017
RADAR Simulator 6200266950311117 JAN 11TH, 2017
ARPA Simulator 6200266950211112 JAN 14TH, 2017
ISM CODE 1260ISM-01000112 NOV 11TH, 2015
SSO 6200266950241117 JAN 12TH, 2017
ECDIS 6200266695022815 NOV 11TH, 2015
5. MEDICAL REPORT / YELLOW BOOK
Item's Date of Issue Date of Expiry Remarks
Physical Inspection
Yellow Fever

6. ABILITY

Item's A (Good) B (Sufficient) C (Poor) Remarks

Attitude A (Good)
 English A (Good)

Steering control A (Good)

Winch control A (Good)

Crane control A (Good)
Watch keeping A (Good)
Welding skill
Day work A (Good)
Cargo work A (Good)
Sincerity A (Good)

7. WORKING EXPERIENCE ( Listing from the last vessel )

Gross Tonnage
Vessel’s Name Vessel type Name of Company /
Engine Sign on & Off Total Remark
Flag Rank Owner's
Type/HP/KW
MV.GEMBIRA GENERAL CARGO 5252 19.01.2009 1 year
FC
INDONESIA DECK CADET 21.01.2010
MV.SAKTI CEMENT CARRIER 4322 15.10.2010 8 month PROMOT
E TO
MALAYSIA 3RD/OFF 28.06.2011 2ND/OFF
MV.SAKTI CEMENT CARRIER 4303 28.06.2011
8 month FC
MALAYSIA 2ND/OFF 02.01.2012
MV.QUEEN ARROW CEMENT CARRIER 5979 16.03.2012
1 year FC
SINGAPORE 2ND/OFF 22.01.2013
MV.ONTOSENO I GENERAL CARGO 5227 23.01.2013
8 month FC
INDONESIA CHIEF OFFFICER 15.08.2013
MV.QUEEN ARROW CEMENT CARRIER 5979 30.08.2013
8 month FC
SINGAPORE 2ND/OFF 11.02.2014
MV.TANGGUH GENERAL CARGO 5489 12.02.2014
FC
INDONESIA 2ND/OFF 02.10.2014 8 month
MV.SAKURA EXPRESS RORO 3636 10.01.2015
7 month FC
INDONESIA CHIEF OFFFICER 27.07.2015
MV.SENANG II GENERAL CARGO 5003 01.09.2015
8 month FC
INDONESIA 2ND/OFF 11.04.2016
MV.GIAT CEMENT BULK 14454 17.05.2016
8 month FC
SINGAPORE 2ND/OFF 13.01.2017

8. MIX'S BY FOREIGNER CREW'S

NO KIND OF COUNTRY ENGLISH LANGUAGE

ABILITY
1 ACCEPTABLE

TRADE / ZONE
Applicant
Crew's Name ; RENTA FEDLIN Signature
Man' Director :

I ( SEAMAN ) WARRANT THAT ALL INFORMATION STATED BY ME IN APPLICATION IS TRUE AND CORRECT IN ALL RESPECTS