CURRICULUM VITAE

Full Name (Underline Surname) Age Nationality

ANGGIE MELBALLYA ANNISA SUHARDI 23 INDONESIA
Place of birth Date of Birth Religion
BANGKALAN 21 June 2001 MOSLEM
Sex / Marital Status Mobile Phone: Name of Father:
Female / Single (+62) 812 3519 4902 Didik Suhardi
Email: Mobile Phone:
[email protected] (+62) 813 8224 0969
Address Address of Parent :
Jl. Nangka 3 No. 3 RT 02 RW 05 Jl. Nangka 3 No. 3
Perumnas Kecamatan Kamal, Kabupaten Bangkalan RT 02/ RW 05
Jawa Timur 69162 Kecamatan Kamal
License Kabupaten Bangkalan
Deck Officer Class III Jawa Timur 69162
Passport Issue at Issued Date Expiry Date
C8099173 TANJUNG PRIOK 05 Aug 2021 05 Aug 2026
Seaman Book No. Issued at Issued Date Expiry Date
G 065665 TANJUNG PERAK 19 March 2024 15 Apr 2026
Certificate of Competency Issued at Issued Date Expiry Date
6212011876N30524 SURABAYA 28 February 2024 -
Certificate of Endorsement Issued at Issued Date Expiry Date
6212011876N30524 SURABAYA 28 February 2024 28 February 2029

Details of Previous Sea Service

Flag GRT Period of Service
Type of Company/
Rank Name of Vessel Management
IMO Number Vessel DWT Sign-ON Sign-OFF Months Days

GAS WIDURI LPG

PT
Experience : NCV INDONESIA 18273 GT PERTAMINA
Carrier 03 26
Deck (Indonesian Waters) ; Dry INTERNATIO
September September 12 17
Cadet Dock; SIRE,STS- as Shuttle NAL
Fully 2021 2022
Ship (±7); Cargo: LPG 9590668 17400 DWT SHIPPING
Refrigerated
Butane & Propane (PIS)
 Personal Qualification Certificate Number Issued By Issue Date Valid

27 September 27 September
GMDSS 6212011876G10523 SURABAYA
2023 2028

Endorsement GMDSS 6212011876GA0523 SURABAYA 02 October 2023 02 October 2028

General Operator Certificate (GMDSS) /

111225/SOU/III/2024 SEMARANG 13 March 2024 13 March 2029
ORU
Survival at Sea Basic Safety Training 27 April 2025
6212011876010520 SURABAYA 27 April 2020
(BST) (Revalidasi Process)
Proficiency in Survival Craft and
6212011876040523 SURABAYA 22 December 2023 22 December 2028
Rescue Boats (SCRB)

Advance Fire Fighting (AFF) 6212011876060521 SURABAYA 09 July 2021 09 July 2026

Medical First Aid (MFA) 6212011876070521 SURABAYA 09 July 2021 -

23 September
Medical Care on Board (MC) 6212011876080521 SURABAYA -
2021
23 September
Bridge Resource Management (BRM) 6212011876230521 SURABAYA -
2021
ECDIS - Operational use of ECDIS
6212011876280523 SURABAYA 22 December 2023 -
Training Programme
Dangerous, Hazardous Harmful
Cargoes (IMDG Code) Training 6212011876290524 SURABAYA 22 April 2024 -
Programme

RADAR Simulator Certificate 6212011876030521 SURABAYA 09 July 2021 -

ARPA Simulator Certificate 6212011876020521 SURABAYA 09 July 2021 -

Basic Training For Oil And Chemical

6212011876390521 SURABAYA 18 February 2021 -
Tanker Cargo Operations (BOCT)
Basic Training For Liquefied Gas
6212011876370521 SURABAYA 18 February 2021 -
Tanker Cargo Operations (BLGT)
Advanced Training For Liquefied Gas 03 November 03 November
6212011876380523 SURABAYA
Tanker Cargo Operations (ALGT) 2023 2028
Advanced Training For Oil Tanker
6212011876410524 SURABAYA 27 February 2024 27 February 2029
Cargo Operations (AOT)

Ship Security Officer Certificate (SSO) 6212011876240523 SURABAYA 22 December 2023 -

Security Awareness Training (SAT) 6212011876310520 SURABAYA 22 December 2023

Seafarers With Designated Security

6212011876320520 SURABAYA 22 December 2023
Duties (SDSD)

Crowd Management 6212011876130521 SURABAYA 18 February 2021

Crisis Management And Human

6212011876170521 SURABAYA 18 February 2021
Behaviour
International Safety Management Code
6212011876570520 SURABAYA 04 December 2020
(ISM Code)
Medical Document Certificate Number Issued By Issue Date Valid
Yellow Fever L00-0916699 JAKARTA 10 Agustus 2021 Life Time

Certificate of COVID-19 Vaccination

24003521 KAMAL 13 Agustus 2021 -
(1st Dose) SINOVAC COVID-19

Certificate of COVID-19 Vaccination

24005521 TG. PRIOK 02 November 2021
(2nd Dose) SINOVAC COVID-19
Certificate of COVID-19 Vaccination
(3rd Dose) Vaccine ASTRA ZENECA D202109010 TG. PRIOK 07 Maret 2022 -
COVID-19

PPE & Clothing Size

Boiler Suit Safety Shoes Shirt Pants
S 38 S 28

Declaration To Be Signed By the Applicant Anggie Melballya A.S

Signature of Applicant

I hereby certify that the information contained in this form is complete &
correct. I understand that the Company may terminate my service at any time
if any of the above information is found to be false.

19 June 2024
Date