Document No.
001
Revision No. & Date 001 – 17/08/2022
Page 1 of 2
CV
Date: 29 NOV 2023
To: MARINE QA & CU,
Marine Department
Dear Gents,
Please find below our crew member whose CV we would like to submit for approval for our future crew rotation.
Company name HIGH SEAS Marine & Industrial Services Co. Ltd
Vessel Name MV- Tamimi 5 Vessel type Crew Boat
LP Surname Name(s) Rank Nationality Date of Birth
1 RATNO DWI CHIEF ENGINEER INDONESIAN 02.02.1976
Passport No E3703382 Issue Date 26.05.2023 Date of Expiry 26.05.2033
07.02.2025
Seaman Book No F108371 Issue Date 09.09.2020 Date of Expiry
PERSONAL PROFILE
Place of Birth KEDIRI Age 47 Weight 85
Height (CM) 170 Phone +6281339487550 Email Dwiratno48gmail.com
Coverall size XL Banjaran 1 / 96 E RT 05/RW
Safety shoe
43 Address 08 Kec Kota Kediri jawatimur
Postal Code 64182 size
indonesia
Next of kin relation WIFE phone +6282233500917
Crewing Agency & Previous Aramco Approval (If Any).
Crewing Agency name DIRECT HIRED
Address, and contact NA
Previous Approval Letter (If any) Mention the QACU Letter Number NA
Reason for Application Apply for chief Officer on Tamimi 5
Medical Certificates & Marlins test -
Medical Fitness for Seafarers Certificate number -
Issued by GLOBAL MEDIKA
Date of Issue 07.17.2023 Date of Expiry 07.17.2025
Remarks on health condition (Fit or Not Fit) FIT
English Marlin test YES
If yes, Certificate no 7213C77048FAF523
(minimum 80% of all test categories)/ Yes/No
CERTIFICATE OF COMPETENCY
Date of Issue 08.12.2017
STCW COC NO 6200500140T10217 Date of Expiry UNLIMITED
Issuing Authority INDONESIA
Date of Issue 23.02.2022
Endorsement No 6200500140TA0217 Date of Expiry 23.02.2025
Issuing Authority INDONESIA
STCW Certificates:
Certificates Place Issued Number Date of Issue Date of Expiry
Basic Safety Course /PST SURABAYA 6200500140010521 11.05.2021 11.05.2026
Advanced Firefighting /AFF SEMARANG 6200500140060320 27.11.2020 27.11.2025
Medical First Aid / MFA SEMARANG 6200500140070321 10.03.2021 10.03.2026
Medical Care on board / MC SEMARANG 6200500140080320 23.12.2020 23.12.2025
Proficiency in Survival Craft and Rescue Boat / PSCRB SEMARANG 6200500140040320 26.11.2020 26.11.2025
No.26.524/ism/PIP
ISM CODE SEMARANG 13.03.2006 UNLIMETED
.SM G/III/06
Ship Security Officer / SSO SEMARANG 6200500140240321 24.03.2021 24.03.2026
BRM / ERM SEMARANG 6200500140270321 10.03.2021 10.03.2026
Security Awareness Training / SAT SEMARANG 6200500140310320 11.01.2021 11.01.2026
Designated Security Duties / SDSD SEMARANG 6200500140320320 02.02.2021 02.02.2026
H2S (OPITO or Hydrogen Sulfide)
DECLARATION OF APPLICANT
Answer Yes or No to the following questions: Yes No
1 Have you ever applied to join GGOMS/GIL/GGOS before? If Yes, please
NO
state the date and position.
2 Have you ever been convicted in a court of law?
If Yes, state the date of offence and penalty. NO
3 Have you ever been placed on probation for criminal offence or detained for any other reasons?
If Yes, state the date and offence. NO
4 Have you ever suffered from any serious illness or physical defecates? Epilepsy? If Yes,
please state details. NO
Applicant’s Signature: Date / Signature of Interviewer Name (office use only):
