Pre Embarkation Checklist

BOA-FRM-K3.0002

CREW ID NAME ACHMAD MULYANA RANK MASTER

VESSEL ANGGUN PORT OF EMBARKATION BATAM DATE

EXPIRY ISSUE EXPIRY

CERTIFICATE NO ISSUE DATE TRAVEL DOCUMENT NO
DATE DATE DATE
1 CERT. OF COMPETANCY 6200060385N10114 12/18/2014 12/18/2019 1 NATIONAL PASSPORT C0138179 11/18/2018 11/18/2023

2 STCW ENDORSEMENT 6200060385NA0114 12/18/2014 12/18/2019 2 NAT'L SEAMANBOOK F135004 5/8/2018 5/8/2021

3 GOC/GMDSS 6007/SOU/V/2017 5/9/2017 5/9/2022 3 NAT'L SEAMAN ID CARD

4 DECK RATING WATCHKEEPING 4 PRE-EMPLOYMENT MEDICAL WITH OFFICE

5 ENGINE RATING WATCHKEEPING 5 DRUG & ALCOHOL WITH OFFICE

6 BASIC SAFETY TRAINING 6200060385010110 5/22/2017 5/22/2022

ISSUE EXPIRY
7 FAST RESCUE BOAT CLIENT REQUIREMENT NO
DATE DATE
8 PSCRB 6200060385040717 5/12/2017 5/12/2022 1 CLIENT APPROVED MEDICAL WITH OFFICE

9 BOSIET WITH HUET EBS WITH OFFICE 7/1/2019 Please state client: PETRONAS

10 DYNAMIC POSITIONING (B/A/O) NI 11882 8/11/2015 8/11/2020 2 TYPHOID

11 TANKER FAMILIARIZATION 6200060385090103 2/10/2003 3 HEPATITIS A

12 ADVANCED CHEM. TANK. 4 STOOL TEST

13 MEDICAL FIRST AID 6200060385070214 7/16/2014 VALID 5 YELLOW FEVER

14 MEDICAL CARE ONBOARD 6200060385080214 8/8/2004 VALID 6 HYDROGEN SULPHIDE SAFETY

15 SHIP SECURITY OFFICER (SSO) 6200060385240209 8/3/2009 VALID 7 RIGGING & SLINGING

16 ARPA SIMULATION 6200060385021119 5/20/2019 5/20/2024 8 ENCLOSED SPACE ENTRY

17 RADAR SIMULATION 6200060385031119 5/20/2019 5/20/2024

ISSUE EXPIRY
18 ADVANCED FIRE FIGHTING 6200060385060717 5/15/2017 5/15/2022 FLAG DOCUMENT NO
DATE DATE
19 BTM/BRM 6200060385230219 4/10/2019 4/10/2024 1 SINGAPORE MPA COE-COC

20 FOOD HANDLING COURSE 2 SINGAPORE IDA COE-GOC

21 DESIGNATED SECURITY DUTIES

22 SECURITY AWARENESS 1 MALAYSIA COR 55428 8/14/2019 12/18/2019

23 ECDIS 6200060385281119 5/14/2019 5/14/2024 2 MALAYSIA INTERIM COR

3 MALAYSIA SID 201923041774 8/14/2019 8/13/2020

OTHERS CHECK 4 MALAYSIAN MEDICAL

1 CURRICULLUM VITAE 5 PETRONAS AME MEDICAL

2 EMPLOYMENT CONTRACT

3 ALLOTMENT SLIP 1 LUXEMBOURG COE - COC

4 PHOTO 2 LUXEMBOURG COE - GOC

5 PPE - SAFETY SHOES 3 LUXEMBOURG SEAMANBOOK

6 PPE - COVERALL

1 PANAMA COE - COC

EXPIRY
VISAS NO ISSUE DATE 2 PANAMA COE - GOC
DATE
1 3 PANAMA MEDICAL

4 REMARKS / SPECIAL INSTRUCTION

Signature of Seafarer DATE Bourbon Offshore Asia Office Rep. DATE

Version CR (BOA-FRM-0202.0002). Original date: 01 February 2018. Version date: NA.

Form Prepared by: Crewing Manager. Approved by: Crewing Manager. Validated by: Quality Representative.