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Form 22

IMMIGRATION ACT
(CHAPTER 133)

IMMIGRATION REGULATIONS
CREW LIST

Name of Vessel / Nama Kapal : Logindo Energy


Gross Tonage / GT Kapal : 3594 T
Agent in Port / Keagenan :
Owner's / Pemilik : PT. Logindo Samudramakmur Tbk
Date Of Arrival / Tanggal Tiba :
Date Of Departure / Tanggal Beran :

No. Name / Nama Awak Sex / Date of Birth / Nationality /


Jenis Kelamin Tanggal Lahir Kebangsaan
1 YANCE AKBAR M 19-Jan-1979 INDONESIA
2 SUGIARTO M 29-Sep-1981 INDONESIA
3 MAGISTER MANURUNG M 20-Jul-1993 INDONESIA
4 HENDRA SITANGGANG M 22-Aug-1979 INDONESIA
5 FERNANDO SIMATUPANG M 27-May-1988 INDONESIA
6 DIRGANTARA M 14-Sep-1982 INDONESIA
7 STEVEN HENRY MAULANY M 25-Apr-1970 INDONESIA
8 JENI DAHLAN M 24-Dec-1986 INDONESIA
9 RONNY M 18-Feb-1982 INDONESIA
10 FIRDAUS M 11-Dec-1977 INDONESIA
11 IRAWAN HARIANTO M 14-Sep-1979 INDONESIA
12 RIDWAN M 28-Jan-1982 INDONESIA
13 ALDI ALATTAS M 20-Feb-1984 INDONESIA
14 ABDUL KHALIK M 15-Sep-1979 INDONESIA
15 GILANG ENGGAR ALIKA PUTRA M 12-Aug-2001 INDONESIA
16 DIKY FAHRULI M 23-Dec-2001 INDONESIA

Total Crews / Total Awak : 16 Person included master.


Acknowledge
Harbour Master
Form 22
MIGRATION ACT
CHAPTER 133)

TION REGULATIONS
CREW LIST

Last Port / Pelabuhan Sebelumnya


Next Port / Pelabuhan Selanjutnya

Travel Document No. / Doc.Of Travel Expired / Duties on Board /


No. Buku Pelaut Tanggal Berakhir Buku Pelaut Jabatan
G 044421 18-Mar-2024 MASTER
F 249319 5-Jul-2024 CH OFFICER
G 015646 27-Jul-2023 2ND OFFICER
F 214171 1-Feb-2024 CH. ENGINEER
F 112464 22-Feb-2023 2ND ENGINEER
F 004301 27-Mar-2024 3RD ENGINEER
F 239169 16-May-2024 BOSUN
F 004181 27-Mar-2024 AB
F 208002 11-Jun-2024 AB
E 110371 23-Aug-2023 AB
F 045976 3-Jul-2024 OILER
F 018426 12-Aug-2024 OILER
F 263043 22-Jan-2024 OILER
G 108108 18-Nov-2024 COOK
H 022058 4-Apr-2025 DECK CADET
G 066804 1-Apr-2025 CADET ETO

er.
October 11th, 2022

Master

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