Curiculum Vitae

No Name
1 Marital status
2 Contact Number
3 Date of Bert
4 Address
5 Religion
6 Email
7 Next of Kind
8 Coverall
9 Safety Shoes

Additional Certificate
No Type Of Document
1 Passport No
2 Seaman Book No
3 Yelow fever
4 Medical FTW Petronas
5 Bosiet + Huet
6 DP Induction
7 Active Assesment Exercise certificate
8 OSP Petronas
9 COR-Certificate of Recognition
10 Seaman ID Malaysia
11 First Aid-DFA
12 Shell safety pasport(Pass Set test)
13 Permit to Work (Shell)
14 Riging and slinging
15 Medical FTW P&I Ship Owners
16 H2S

Certificate of Competency

No Type of Certificate
1 Deck officer Class-I
2 Endorsement of Certificate Class I
3 Certificate of GMDSS Radio Operator
4 COE Certificate of GMDSS Radio Operator
5 O.R.U/Operator Radio Umum

Certificate Of Proficiency

No Description of Certificate
1 Basic Safety Training-Revalidation
 2 Proficiency In Survival Craft and Rescue Boat – Revalidation
3 Medical First Aid-Revalidation
4 Medical Care On Board Ship-Revalidation
5 Advanced Fire Fighting-Revalidation
6 Ship Security Officer – Revalidation
7 Security Awareness Training
8 Seaferer with Designated Security Duties
9 Radar Simulator – Revalidation
10 Arpa Simulator – Revalidation
11 Operational Use Of ECDIS Training Programme- Revalidation
12 Bridge Resources Management
13 Basic training for Liquified Gas Tanker Cargo Operations
14 Basic training for Oil Chemical Tanker Cargo Operations
15 Advanced training for Oil Chemical Tanker Cargo Operations
16 Advanced training for Oil Tanker Cargo Operations
17 Advanced training for Liquified Gas Tanker Cargo Operations
18 Crowd Management Training
19 Crisis-Management and Human Behavior Training
20 International Maritime dangerous Good

Experience

No Name of Ship

1 AHTS. Temasek Sepinggan

2 AHTS. Temasek Sepinggan
3 SV.Tropic Orion
4 SV.Osam Eagle
5 SV.Osam Eagle
6 MV.Aladin
7 MV.Java Insignia
8 MV.Java Imperia
9 AHTS.Temasek Sepinggan
10 MV.Target 36
11 AWB.Crest Station 5
12 AWB.Crest Station 5
13 AWB.Crest Station 5

For detail certificate of competency (COC) and certificate of proficiency (COP ), please click www.pelaut.go.id
 Curiculum Vitae
Teguh Agung Kusuma
Marriage
+62-813-2761-1796
Purworejo 29 July 1990
Donorejo RT06/RW01, Kaligesing, Purworejo- Indonesia
Moslem
teguhagungkusuma@gmail.com
Wife,Patty Maya Nevyta Suseno, +6281-22806-0222
L
42

Document Number Date issue

B 6972104 10th April 2017
C 032052 23th Sept 2013
B-151064 23th June 2017
C : 226085 16th Jan 2019
645707010618310000 01st June 2018
17316518 9th Nov 2018

52493 20th Des 2018

201823036973 19th Des 2018
SN: FA 21942/18/33296 11th July 2018
A 664411
Valid 27th Jun 2019
SG 112491-016-R&S 28th May2019
00003/002/XI/SWP/19 07th Nov 2019

rtificate of Competency

Certificate Number Place Issued

6200350403N2020 Jakarta
6200350403NB0220 Jakarta
6200350403G15320 Jakarta
6200350403GA5320 Jakarta
39769/SOU/V/2014 Jakarta

Certificate Number Place &Date of Issued

6200350403010316 Semarang 2016-05-30
 6200350403040316 Semarang 2016-05-30
6200350403070316 Semarang 2016-05-30
6200350403080316 Semarang 2016-05-30
6200350403060316 Semarang 2016-05-30
6200350403240316 Semarang 2016-05-30
6200350403310114 Jakarta 2019-12-04
6200350403320114 Jakarta 2019-12-15
6200350403030318 Semarang 2018-04-24
6200350403020318 Semarang 2018-04-24
6200350403280318 Semarang 2018-04-24
6200350403232514 Semarang 2014-06-11
6200350403370114 Jakarta 2019-12-01
6200350403390114 Jakarta 2019-12-22
6200350403400116 Jakarta 2016-05-16
6200350403410316 Jakarta 2016-05-26
6200350403380316 Jakarta 2016-09-15
6200350403130217 Jakarta 2017-05-17
6200350403170217 Jakarta 2017-05-17
6200350403290217 Jakarta 2017-05-16

Company Vessel type

Chuan Hup Offshore Pte Ltd AHTS

Chuan Hup Offshore Pte Ltd AHTS
Chuan Hup Offshore Pte Ltd Suply Vessel
Chuan Hup Offshore Pte Ltd Suply Vessel
Chuan Hup Offshore Pte Ltd Suply Vessel
Sovereign Global Solution Workboat/4 P Mooring
Asean Geos Sdn bhd Survey Vessel
Asean Geos Sdn bhd Survey Vessel
Chuan Hup Offshore Pte Ltd AHTS
Annur marine Sdn bhd Utility
Pasific Radiance Pte Ltd AWB/8 P Mooring
Pasific Radiance Pte Ltd AWB/8 P Mooring
Pasific Radiance Pte Ltd AWB/8 P Mooring

ertificate of proficiency (COP ), please click www.pelaut.go.id

Date expired Place Issued
10/05/2022 Imigrasi, Jakarta 728
26/04/2020 Syahbandar, Semarang -16
15/05/2020 KKP Soekarno-Hatta, Jakarta 3
14/01/2021 Hospital Pusrawi sdn bhd 247
31/05/2022 MSTS, Johor 749
09/11/2023 DPTC Semarang 1276

24/05/2019 Malaysia marine Departmen Headquaters -354

18/12/2019 Jabatan Laut Malaysia -146
10/07/2020 Cert, Bintulu 59
Shell Serawak sdn bhd
27/06/2021 Shell Serawak sdn bhd
27/05/2021 BSTC Batam
11/7/2021 Yogyakarta,Klinik Anugerah Ibu

Date Issued Date expired

1/22/2020
1/29/2020
1/29/2020
1/22/2020 1/29/2025
3/22/2019 3/22/2022 679

Date expired
5/30/2021 383
 5/30/2021 383
5/30/2021 383
5/30/2021 383
5/30/2021 383
5/30/2021 383
12/4/2024 1667
12/4/2024 1667
4/24/2023 1077
4/24/2023 1077
4/24/2023 1077
6/11/2024 1491
12/1/2024 1664
12/22/2024 1685
5/16/2021 369
5/26/2021 379
9/15/2021 491
5/17/2022 735
5/18/2022 736
5/16/2022 734

Periode
Grt/Hp Rank
From To
1032/4058 Cadet 9/4/2012 5/19/2013
1032/4058 2nd Mate 6/5/2014 9/8/2014
1200/7500 2nd Mate 10/11/2014 10/12/2015
1215/2200 Chief Mate 20/12/2015 9/15/2016
1215/2200 Chief Mate 15/9/2016 4/27/2017
1625/4058 Chief Mate 5/6/2017 12/25/2017
1612/2180 Chief Mate 2/1/2018 6/4/2018
1315/7400 Chief Mate 6/6/2018 10/3/2018
1032/4058 Master 10/5/2018 1/27/2019
499/3200 Chief Mate 2/2/2019 5/2/2019
18492 Chief Mate 27/6/2019 9/27/2019
18492 Chief Mate 7/10/2019 11/1/2019
18492 Chief Mate 5/11/2019 12/20/2019
 Reason of sign off

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