PT.

Waruna Nusa Sentana /POK

From 22
Imigration Act

Chapter 133

Name of Vess : MT. CHAMPION ONE Date Arrival : SURABAYA

Gross Tonnag : 22555 Date Departur : CILACAP
Owner : PT. WARUNA NUSA SENTANA Last Port : CILACAP
Next Port : TJ.WANGI

Crew List

No. Name Rank Sex Place & Date Birth Nationality

No. No. Sign On
M/F Seaman Passport Date
Book
1 ROBERT MASTER M BONE, 16/12/1974 INDONESIA E 007131 B 12-Sep-
TAMPUBOLON 2132440 2018
2 NOLDI.W. CHIEF M PAMONA, INDONESIA A 005261 A 23-May-
RATOSIGI OFFICER 29/11/1978 9330907 2018
3 GATTOT 2/O M PADANG, 26/08/1988 INDONESIA F 073562 B 4-Oct-
2782322 2017
4 RAMA SURYA 3/O M JAKARTA, INDONESIA E 108969 B 10-Jan-
12/05/1992 1199150 2019
5 YUDA FIRDAUS 4/O M SURABAYA, INDONESIA D 075084 B 23-Aug-
22/03/1993 1490662 2018
6 MUH. SIDDIK CHIEF M PINRANG,14/09/1965 INDONESIA A 051466 A 18-Sept-
ENGGINER 8652859 218
7 RAZALI 2/E M BELAWAN, INDONESIA C 039601 B 1-July-
13/04/1968 0071558 2016
8 FAHMI PUTRA 3/E M MAKASSAR, INDONESIA C 069715 A 4-May-
22/01/1988 9553955 2017
9 SAFRIL GURUH 4/E M MEDAN, 28/06/1994 INDONESIA D 019727 A 8-Jan-2018
9194042

POK – 254Rev 00 / Feb 2018

PT. Waruna Nusa Sentana /POK

10 FEBRIO GUSTI 5/E M MALANG, INDONESIA C 062268 A 10-Aug-

10/11/1992 7942809 2016
11 RINTO BOSUN M PALOPO, 21/05/1982 INDONESIA C 077042 B 7-jan-2016
0143445
12 KURNIAWAN OILER 1 M PALOPO, 13/11/1985 INDONESIA W 062602 B 21-May-
8032243 2018
13 MOH.AMIN OILER 2 M MADURA, INDONESIA E 024896 B 14-Dec-
12/12/1985 2400850 2017
14 RENDY JULIAN OILER 3 M JAKARTA, INDONESIA A 059683 A 30-May-
06/06/1988 8062786 2017
15 SUDARMAN PUMP M SURABAYA, INDONESIA E 098398 B 8-Jan-2018
MAN 01/03/1989 1891026
16 ADI AB 1 M MAKSSAR, INDONESIA F 106796 A 15-Dec-
14/10/1990 4814597 2019
17 WAHYU DWI AB 2 M SEMARANG, INDONESIA Y 065662 B 20-Ect-
20/09/1990 1890531 2016
18 RAIGUS AB 3 M MAKASSAR, INDONESIA F 138406 B 14-Dect-
26/10/1991 5395384 2017
19 IZHAR MES BOY M BOYOLALI, INDONESIA C 085900 B 3-May-
30/12/1978 8032189 2018
20 EKO SETYO OS M BLORA, 12/04/1982 INDONESIA F 055147 A 1-Jul-2016
4781853
21 NARSULOH CH.COOK M MEDAN, 09/03/1980 INDONESIA B 918473 B 1-Aug-
4654645 2018
22 FERRY CADET M SAMOSIR, INDONESIA C 332949 C 18-Jan-
NAINGGOLAN DECK 26/01/1996 1304074 2019
23 WILSON CADET M JAKARTA, INDONESIA B 040584 B 8-Feb-
FERNANDUS DECK 21/03/1997 8530558 2019
24 BAGAS ENG M SEMARANG, INDONESIA F 182406 C 18-Jan-
PUJIOKTAVIAN CADET 13/10/1996 1305208 2019
25 MUH.SAYAFIKA ENG M BEKASI, 11/10/1998 INDONESIA F 027487 B 3-May-
CADET 2084732 2018
26 MANSUR. S ENG M PINRANG, INDONESIA C 875435 A 2-Aug-

POK – 254Rev 00 / Feb 2018

PT. Waruna Nusa Sentana /POK

CADET 21/06/1994 1238947 2018

Acknowledge by:

Master

POK – 254Rev 00 / Feb 2018