MLC Manual

SECTION I: Appendix 1.2 (a) Rev. 4.0

111
Dare of Issue : 17 Jul 20 19 Page 113
SEA STAFF PRE-JOINING CHECKLIST
OFFICERS (DECK & ENGINE)
KYAW
Cre\\ Namc/IPN: - - -- - THET
- - -AUNG/MMRU00694
- - - - - - - - - - - -- - CO
Rank: _ _ _ _ DOB: _14.10.1974
_ _ _ _ _ __

Vessel: KOTA LUMBA Join ing Date & Place: 19/10/22-SINGAPORE Bank Account: YES D
otes:
I. Individual crew is responsible to complete this checklist with all original certificates in hand .
2. Manning Agent/M P D Starf (for crew w ithout agent) to countercheck and ensure correctness of MLC Checklist.
3. Upon joining vessel, handover this checklist along w ith relevant documents to Master for verification again.
Master is required to sight a ll origina l documents, verify the declaration, tick in the appropriate column and endorse on it.
4. This checklist to be filed on board a fter verification by Master and send a copy to MPD for record.

v~::s 0 NOT APPLICABLEINIAI

Sea 1\IPD/
A. TRAVEL DOC UMENTS Stnfl' Al(ent .\laster

I. International Passport (validit) must not b.: less than intended contract period + 6 months)
Passpo11 o: MG421285 Expiry Date: 02/09/2027

2. Visa
Country:_ Visa Type: Expiry Date:
- Visa Type: Expiry Date:
Country:
3. Conti nuous Discharge C ertificate (CDC) I Seaman Book (validi ty must not be less than intended
.:ontra~t p~nod + 3 mornh~
I Number: 41480 Country Issued: MMR Expiry Date: 25/02/2028
Pa nama C DC ( for Pa na m a nag vessel only)or Liberia Sl RB (for Liberia nag vessel only) or
Ma rs hall Island S IRB (for Ma r sh all Island only) .
Number: Country Issued: Expiry Date:

B. COC,GMDSS & COE Sea t\IPD/

.\laster
Staff Agent
I. Certifica te of Competency updated with STCW 20 I0 (\alidity must not be less than intended contract period +
3 111\lnth:,)
Certificate No: 1DK001549 Country Issued: MMR Exp iry Date: 23/11/2026
COC limitation if an)

2. Ccrti ticate of Endorsem ent (COE) by MPA or HK M AROEP or Panama P M A or Liberia

LMA or Ma rsha ll Isla nd
Certificate No: Expiry Date:
I ROA , CRA No: 2022037663
-- Expiry Date:

3. G M DSS - G O C (For Decl{ Officers) (validi ty nn~>t not bl! les~ than intended contract period + J months )

Ccrtilicate No: Country Issued: Expiry Date:

GMDSS Limitation ifan)

-t. Certifica te of E ndo rsement (COE) by IDA or HK MARDEP or Panama PMA or Liberia
SC D or Marsh all Is la nd
Certificate No: Expiry Date:
ROA CRA \Jo: 2022037663 Expiry Date:

Sea t\ ll>l)f .\I<! SIC!'

C. COU RSE CERTI F ICAT ES Staff Agent

Advance Fire Fighting (A FF) I Medical First Aid (MFA) I Proficiency in Survival Craft and Rescue
Boat (PSCRB) ' Basic Training (BT)
Dcsi!!.nated Security Duties (DSD) - STCW VI I 6
MLC Manual
SECTION I: Appendix 1.2 (a) Rev. 4.0 ·
111
Date of Issue : 17 Jul 2019 Page 2 13

OFFICERS (DECK & ENG INE) I Sea

Staff
"PDf
\gent
\la,t!•r I

I
1. ECDIS Training Certificate - Generic IMO 1.27 (STCW A - 11/ 1, ll/2, 11/3)
- -

2. Type Specific ECDIS- JRC

- Transas
- Furuno
3. Ship Security Officer (SSO) - STCW VI I 5
...,
4. Hazardous Material (HAZMAT) (For Container Vessel only, validity 3 years)
5. Bridge Resource Management (BRM)
6. Medical Care - Master & C/0 only
-
7. High Voltage
8. Engine Room Resource Management (ERM)

I D. OTHER CERT IFICATES (i f any) - - - - -- - - - -- - - - - - -- - - - - - - - - - J

E. MEDICAL CERTIFICATE Sr:~ ;\I PDf

\la ~ter
Staff .\gent
I. Medical Certificate with '"FIT FOR SEA SERVICE I DUTY' status
(vali dity must not be less than intended contract period + 3 months)
Issue Date: 01/07/2021 Expiry Date: 30/06/2023
Restrictions I Fit with Medication / Any other remarks, if any: - - -
Panama Medical Certificate with "FIT FOR SEA SERV ICE I DUTY" status:
Issue Date: - - - - - Expiry Date:
Restrictions I Fit with Medication/ Any other remarks, if any:

2. Stress Test (for seafarers of 51 years and above)

Issue Date: Expiry Date:
Remarks (If Any):
3. Valid Yellow Fever Vaccination (validity must not be less than intended contract period + 3 months)
Issue Date: 01/07/2022 Expiry Date: LIFE LONG

F. SEA Sea "1'1)/

\lm.l l' r
Stall .-\gent

I . SEA (Signed copy received by seafarer)

2. Read and understand terms and conditions of SEA Annex I

G. OTHERS Sea
Staff
'11'1)/
.-\gent
\ l;t,t<·r
I

1. PlLCOPS completion
•
2. Uniform I Boiler Suits I Safery Shoes
1
3. Aware of the joining vessel trading area?
(High Risk Area /Piracy Area I War Zone Area) I
Rentarksifany: ________________________________________________________________________
"I hereby confirm that all my certificates are in good condition with my correct name spell. I will
bring along all of my original certifi cates I documents when I join ship as well that all the
information provided in this checklist is true & correct to the best of my knowledge."

Sea StaffS ignature: ------------------=-- Date I Place: ---------------------

MPD / AGENT MASTER

Signature Signature
~PIL
'
NEXT OF KIN DEClARATION

Name of Seafarer KYAW THET AUNG Rank: CO

-------------------
Joining Vessel MV/MT: KOTA LUMBA

In the event of my death during tenure on the above mentioned vessel, death compensation payable if any
should be paid to the following persons as per the percentages indicated below. Balance of Wages and
personal effects should be given to my next of kin whose name is given at serial number 1.

SrNo Names, Address, Tel Relation Percentage

Address proof to collect and retained alongwith this form.

1. DAW THIDAR NAING WIFE FULL

Information regarding Spouse & Children ( in case unmarried then parent's information)

SrNo Name Date of Birth

1. HEIN THANT KYAW 21/09/2007

2. PYAE SANDI KYAW 16/06/2011

Company's I Manning Office Representative

Seafarer's Signature
Signature (as witness)

Date : Date :