Crew Processing Form

All candidates who have received approval must fill out the Crew Data Processing Form below completely and correctly:

Date of Processing (Today)

Position Approved

Name of Ship / Company

KTP No. / NIK

First Name

Last Name

Place of Birth

Date of Birth

Gender

Phone No/ WA

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Passport No.

Passport Place of Issues

Passport Issues Date

Passport Expired Date

Seaman Book No.

SB Issues Date

Seaman Book Expired Date

Your Last Education (School Name)

Duration

School Address

Family/ Contact Person

Some description about this section

Marital Status

Wife's Name

Married Date/ Year

Wife's Place/ Date of Birth

Name of Father

Father Place of Birth

Father Date of Birth

Name of Mother

Mother Place of Birth

Mother Date of Birth

STCW Certificate Information

Please Fill Up Your STCW Information to Check Your Readiness

Basic Safety Training No.

BST Issued Date

Security Awareness No

SAT Issued Date

Crisis Management No

CM Issued Date

Crowd Management No

Crowd Issued Date

Deck & Engine Crew Only

Able Seafarers No

Able Issued Date

Advance Fire Fighting No

AFF Issued Date

Rating Perform No

Rating Issued Date

Fast Rescue Boat No

FRB Issued Date

Processing Status & Information

Visa Required

Visa Application Date

Visa App. Status

Do You Have Valid Schengen Visa

Schengen Issued Date

Schengen Exp Date

Have you done a medical check-up?

If Yes, Medical Date

Medical Check Up Result

Do You Have Valid Yelow Fever?

If Yes, Yellow Fever Expired Date

Have you been vaccinated against Covid-19?

Tipe of Vaccine