Code : 1-FM-003

PT. INTERNATIONAL OFFSHORE SERVICES

Rev : 02
BATAM ISLAND - INDONESIA
Date : 06/04/2018
Presna Centre No 2 - 3
Sagulung Batu Aji, Batam Island 29432 - Indonesia
Telp: (+62) 778-392056, 395008 Fax: (+62) 778-392034
Website: www.ioscrew.co.id

CREW LIST EMBARKATION

NAME : ____________________________ ETD : ____________________________
NO IOS: ____________________________ TIME : ____________________________
RANK:______________________________ VESSEL :__________________________
HP:_________________________________ EMAIL :____________________________

CHECKED
NO DOCUMENT REMARKS
OK NOK
1 Agreement
Certificate (ANTD/ANT IV/ANT III/ANT II/ANT I/ATTD/ATT IV/
ATT III/ATT II/ATT I/RATING DECK/ENGINE/ABLE
2 DECK/ENGINE, BST, SCRB, MFA, AFF, TF, SAT, SDSD, FOOD
HANDLING, SHIP’s COOK/STEWARD, FOOD SAFETY)
3 Passport
4 Seaman’s Book
5 Lux Smb / Belgium Smb
6 Vaccination
7 Medical
8 Drug & Alcohol
9 Letter Guarantee
10 Visa/ OKTB/ Permiso
11 Ticket
12 Form Crew Evaluation
13 Form On Board Complain
14 Others
Check By :
Emergency Call:
IOS Crew Next Kin:
1. 1.
2. 2.
Batam, / /
Crew Head Department

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