NYK SHIP MANAGEMENT PTE LTD

SEAFARERS SERVICE CARD Employee No:N509 Nick name:

FAMILY NAME GIVEN NAME MIDDLE NAME

SHIMABURA ANDHI NOLDI
RANK DATE OF BIRTH AGE
CHIEF OFFICER 25-Jul-1982 40 yrs. old
PLACE OF BIRTH NATIONALITY
JAKARTA INDONESIAN
PERMANENT HOME ADDRESS TELEPHONE
JL.BOUGENVILLE Y 24 RT.007/06 KOJA, 081294713504 (WIFE)

COMPLEXION COLOR OF EYES COLOR OF HAIR CIVIL STATUS

BLACK BLACK Married
HEIGHT (cm) WAIST (cm) WEIGHT (kg) SHOE SIZE (cm)
169.00 75.00 85.00 10.00
NAME OF NEXT OF KIN RELATIONSHIP
AI KOMALASARI SPOUSE
ADDRESS OF NEXT OF KIN

EDUCATIONAL QUALIFICATION

CERTIFICATE NAME OF SCHOOL DATE OF GRADUATION

DECK OFFICER CLASS III MERCHANT MARINE ACADEMY 07 Sep 2006 - 07 Sep 2006
(STIP)

TRAVEL DOCUMENT

NAME NUMBER PLACE OF ISSUE DATE OF ISSUE EXPIRATION

SEAMAN’S I001513 TANJUNG PRIOK 12-Dec-2022 12-Dec-2025
IDENTIFICATION
AND RECORD
BOOK
PASSPORT C8099777 TANJUNG PRIOK 09-Sep-2021 09-Sep-2026
SEAFARER’S
REGISTRY CARD
US C1/D VISA P4847494 JAKARTA 10-Oct-2019 06-Oct-2023
OTHER VISA 2009584221507 BRISBANE, 23-Feb-2021 23-Feb-2024
AUSTRALIA

MEDICAL CERTIFICATE/TEST

NAME NUMBER PLACE OF ISSUE DATE OF ISSUE EXPIRATION

Medical Certificate GENERAL JAKARTA 15-Mar-2021 14-Mar-2023
Aids Test NON REACTIVE JAKARTA 15-Mar-2021 14-Mar-2023
Tredmill Test - JAKARTA 23-Oct-2019 22-Oct-2021
Yellow Fever - JAKARTA 22-May-2014
COVID-19 TANJUNG PRIOK 21-Aug-2021
VACCINATION
CHICKEN POX - JAKARTA 25-Jan-2019
VACCINATION
D&A NON REACTIVE JAKARTA 10-May-2022
PRE-JOINING - JAKARTA 26-Nov-2015
DECLARATION:S-12
PRE-JOINING - JAKARTA 04-Jun-2015
DECLARATION:S-12
PRE-JOINING - JAKARTA 18-Apr-2017
DECLARATION:S-12
PRE-JOINING - JAKARTA 29-Dec-2017
DECLARATION:S-12
PRE-JOINING - JAKARTA 19-Feb-2019
DECLARATION:S-12
PRE-JOINING - JAKARTA 08-Nov-2019
DECLARATION:S-12
PRE-JOINING - JAKARTA 27-Jul-2018
DECLARATION:S-12
ULTRA SOUND - JAKARTA 02-Jun-2014 02-Jun-2016
ULTRA SOUND - JAKARTA 26-Nov-2015
ULTRA SOUND - JAKARTA 12-Dec-2017
ULTRA SOUND - JAKARTA 23-Oct-2019
FLAG MEDICAL - JAKARTA 15-Mar-2021 15-Mar-2023
CERTIFICATE

LICENCE/COMPETENCY GRADE/ ISSUING NUMBER DATE OF EXPIRATI

DOCUMENTS REG AUTHORITY ISSUE ON
MASTER - ENDORSEMENT DGST INDONESIA 6201021082 26-Jun- 26-Jun-
NA0120 2020 2025
MASTER - ENDORSEMENT MPA SINGAPORE COE- 14-Jan- 14-Jan-
D0181767 2021 2026
GENERAL OPERATOR MINISTRY OF ABGR00036 10-Jun-
CERTIFICATE (GOC) LAND & TRANSP. 2008
GENERAL OPERATOR DIRJENPOSTEL 77623/ 10-Sep- 10-Sep-
CERTIFICATE (GOC) SOU/T/IX/ 2019 2024
2019
GMDSS DGST INDONESIA 6201021082 08-Jul-
G10120 2020
GMDSS ENDORSEMENT IMDA SINGAPORE COE- 08-Nov- 10-Sep-
R0147817 2019 2024
GMDSS ENDORSEMENT DGST INDONESIA 6201021082 08-Jul- 08-Jul-
GA0120 2020 2025
JAPANESE INT'L SHIPPING MLITT JAPAN 1117003441 21-Dec- 15-Feb-
SYSTEM LICENSE (JISS) 2021 2023
JAPANESE INT'L SHIPPING MILLT JAPAN 117003441 21-Dec- 15-Feb-
SYSTEM LICENSE (JISS) 2021 2023
SEAMEN IDENTITY BOOK BAHAMAS LON96594 08-May-
MARITIME 2009
AUTHORITY
ENDORSEMENT (GAS) MPA SINGAPORE TEIR- 05-Jan- 26-Jun-
0030621 2021 2025
JISS SSO PRESIDENT OF SSO-9869 20-Nov-
JAPAN MARITIME 2017
EDUCATION
MARITIME LAW NETI1111R 19-Nov-
U)-J1948 2011

TRAINING/UPGRADING CERTIFICATIONS ISSUING AUTHORITY NUMBER DATE OF

ISSUE
ADV. CHEMICAL TANKER OP. DGSC-INDONESIA 6201021082110111 03-Jan-2011
ADV. LIQUEFIED GAS TANKER OP. DGSC-INDONESIA 6201021082120110 21-Jun-2010
ADV.TANKER SAFETY & OPERATION DGSC-INDONESIA 6201021082100111 03-Jan-2011
ADVANCE FIRE FIGHTING DGST INDONESIA 6201021082060119 18-Oct-2019
BASIC SAFETY COURSE DGST INDONESIA 6201021082010120 04-Sep-2020
BRIDGE RESOURCE MANAGEMENT DGST INDONESIA 6201021082230719 23-Jan-2019
ELECTRONIC CHART DISPLAY & DGST INDONESIA 6201021082280719 23-Jan-2019
INFORMATION SYSTEM
ENGLISH LANGUAGE MARLINS U.K 4F5DC29E29DC771 10-Jan-2019
B
GMDSS/INMARSAT DGSC-INDONESIA 6201021082210111 03-Jan-2011
NMC-45 LNG TRAINING (SPECIAL CARGO NYK NYKSM2016-SG1200 10-Feb-2017
WORK COURSE) SHIPMANAGEMENT
PTE LTD
MEDICAL CARE DGST INDONESIA 6201021082080115 16-Mar-2015
MEDICAL EMERGENCY - FIRST AID DGST INDONESIA 6201021082070115 16-Mar-2015
OFFICERS DIALOGUE - 24-Apr-2014
PROFICIENCY IN SURVIVAL CRAFT & DGST INDONESIA 6201021082040120 04-Sep-2020
RESCUE BOAT
RADAR SIMULATOR COURSE DGST INDONESIA 6201021082030115 05-Oct-2015
SHIP SAFETY AND MANG. DGST INDONESIA 06/03/SSO/01/01107 23-Mar-2006
BRIDGE TEAM MANAGEMENT AND DGST INDONESIA 034/BTM/08/06 28-Aug-2006
SIMULATOR
TANKER FAMILIARIZATION DGSC-INDONESIA 6201021082090108 24-Nov-2008
SHIP SECURITY OFFICER (SSO) DGST INDONESIA 6201021082240115 16-Mar-2015
NMC-01 SMS TRAINING (FULL TERM) NYKSM2008-SIN065 22-May-2008
NMC-03 RISK ASSESSMENT & INCIDENT NYKSM2013-SG418 02-Aug-2013
INVESTIGATION TRAINING
NMC-06 BRM/BTM TRAINING NYK NYKSM2014-SG052 16-Apr-2014
SHIPMANAGEMENT
PTE LTD
NMC-24 HYDRAULIC TRAINING NYK NYKSM2018-SG0237 09-Jun-2018
(DECK:ONLY FOR VLCC C/O) SHIPMANAGEMENT
PTE LTD
NMC-42 LNG TRAINING (STANDARD NYK MARITIME TC NYKMART 2008-102 27-Jun-2008
COURSE) LECTURE ONLY
NMC-43 LNG TRAINING (BASIC COURSE) NYK MARITIME TC NYKMART 2008-102 27-Jun-2008
(SIMULATOR TRAINING)
NMC-44 LNG TRAINING (CARGO NYK NYKSM2015-SG366 12-Jun-2015
OPERATION COURSE) SHIPMANAGEMENT
PTE LTD
ARPA SIMULATOR DGST INDONESIA 6201021082020115 05-Oct-2015
NMC-53 - SAFETY OFFICER TRAINING NYK NYKSM2015-SG992 17-Nov-2015
SHIPMANAGEMENT
PTE LTD
NMC-62 LEADERSHIP and MANAGEMENT NYK NYKSM2018-SG0661 08-Nov-2018
SKILLS TRAINING SHIPMANAGEMENT
PTE LTD
BASIC TRAINING FOR LIQUIFIED GAS DGST INDONESIA 6201021082370119 21-Oct-2019
TANKER CARGO OPERATIONS
ADVANCED TRAINING FOR LIQUEFIED DGST INDONESIA 6201021082380119 21-Oct-2019
GAS TANKER CARGO OPS
LNG STARS 0 14-Dec-2016
NMC-18TSF ECDIS TYPE SPECIFIC NYK NYKSM2011-SG799 03-Dec-2015
FURUNO - FEA-2807/2107 SERIES SHIPMANAGEMENT
PTE LTD
NMC-18TSJ ECDIS TYPE SPECIFIC JRC NYK NYKSM2011-SG799 03-Dec-2015
JAN-2000 & JAN 901 SERIES SHIPMANAGEMENT
PTE LTD
NMC-18TST ECDIS TYPE SPECIFIC NYK NYKSM2011-SG799 03-Dec-2015
TRANSAS - NS3000 & 4000 SERIES SHIPMANAGEMENT
PTE LTD
NMC83 - TYPE SPECIFIC TRAINING JRC NYK NYKSM2016-SG0289 17-Jun-2016
JAN-7201/9201 INHOUSE TC SHIPMANAGEMENT
PTE LTD
NMC-06N BRM/BTM TRAINING NYK NYKSM2018-SG0923 01-Feb-2019
SHIPMANAGEMENT
PTE LTD
NMC-90 CYBER SECURITY TRAINING NYKSM2021- 05-Oct-2021
HELMS4942

SERVICE RECORD
VESSEL RANK/ GROSS DATE OF DATE OF DURATION/REASON
CODE/NAME TONAGE & DEPARTURE/ ARRIVAL/ FOR
FLAG/ADDRESS PRINCIPAL POWER / DISEMBARKATION
SIGN ON PORT SIGN OFF
TYPE OF TYPE OF PORT
VESSEL/BUSINESS ENGINE
TANGGUH BATUR / CHIEF / / 13-05-2022 / 03-11- 05 M 23 D /
SINGAPORE / LNG OFFICER / UNKNOWN BITUNG 2022 / END OF CONTRACT
CARRIER NYK YOSU
SHIPMANAG
EMENT PTE
LTD
TANGGUH BATUR / CHIEF / / 06-10-2021 / 16-04- 06 M 11 D /
SINGAPORE / LNG OFFICER / UNKNOWN FSRU NUSANTAR 2022 / END OF CONTRACT
CARRIER NYK BITUNG
SHIPMANAG
EMENT PTE
LTD
TANGGUH BATUR / CHIEF / / 22-03-2021 / 13-08- 04 M 23 D /
SINGAPORE / LNG OFFICER / UNKNOWN FSRU NUSANTAR 2021 / FINISHED
CARRIER NYK FSRU
 SHIPMANAG NUSANTA CONTRACT
EMENT PTE R
LTD
TANGGUH TOWUTI CHIEF / / 29-08-2020 / 12-01- 04 M 15 D /
/ SINGAPORE / OFFICER / UNKNOWN FSRU NUSANTAR 2021 / FINISHED
LNG CARRIER NYK ARUN CONTRACT
SHIPMANAG
EMENT PTE
LTD
TANGGUH TOWUTI CHIEF / / 11-11-2019 / 10-05- 06 M 00 D /
/ SINGAPORE / OFFICER / UNKNOWN ARUN 2020 / FINISHED
LNG CARRIER NYK FSRU CONTRACT
SHIPMANAG NUSANTA
EMENT PTE R
LTD
TANGGUH BATUR / CHIEF / / 21-02-2019 / 07-09- 06 M 20 D /
SINGAPORE / LNG OFFICER / UNKNOWN ARUN 2019 / FINISHED
CARRIER NYK ARUN CONTRACT
SHIPMANAG
EMENT PTE
LTD
TANGGUH BATUR / CHIEF / / 29-07-2018 / 02-11- 03 M 05 D /
SINGAPORE / LNG OFFICER / UNKNOWN ARUN 2018 / FINISHED
CARRIER NYK FSRU CONTRACT
SHIPMANAG NUSANTA
EMENT PTE R
LTD
TANGGUH TOWUTI CHIEF / / 31-12-2017 / 13-05- 04 M 14 D /
/ SINGAPORE / OFFICER / UNKNOWN QINGDAO 2018 / FINISHED
LNG CARRIER NYK ARUN CONTRACT
SHIPMANAG
EMENT PTE
LTD
TANGGUH TOWUTI CHIEF / / 19-04-2017 / 08-09- 04 M 23 D /
/ SINGAPORE / OFFICER / UNKNOWN ARUN 2017 / FINISHED
LNG CARRIER NYK ARUN CONTRACT
SHIPMANAG
EMENT PTE
LTD
TANGGUH BATUR / CHIEF / / 23-08-2016 / 08-12- 03 M 16 D /
SINGAPORE / LNG OFFICER / UNKNOWN ARUN 2016 / FINISHED
CARRIER NYK LAMPUNG CONTRACT
SHIPMANAG
EMENT PTE
LTD
TANGGUH TOWUTI JUNIOR / / 13-12-2015 / 12-05- 05 M 02 D /
/ SINGAPORE / CHIEF UNKNOWN BLANG LANCANG 2016 / FINISHED
LNG CARRIER OFFICER / BLANG CONTRACT
NYK LANCANG
SHIPMANAG
EMENT PTE
LTD
TANGGUH TOWUTI JUNIOR / / 16-06-2015 / 22-09- 03 M 09 D /
/ SINGAPORE / CHIEF UNKNOWN TANGGUH 2015 / FINISHED
LNG CARRIER OFFICER / TANJUNG CONTRACT
 NYK PRIOK
SHIPMANAG
EMENT PTE
LTD
TANGGUH BATUR / JUNIOR / / 09-06-2014 / 19-12- 06 M 12 D /
SINGAPORE / LNG CHIEF UNKNOWN BITUNG 2014 / FINISHED
CARRIER OFFICER / BITUNG CONTRACT
NYK
SHIPMANAG
EMENT PTE
LTD
TANGGUH TOWUTI JUNIOR / / 02-09-2013 / 16-03- 06 M 18 D /
/ SINGAPORE / CHIEF UNKNOWN GWANGYANG 2014 / FINISHED
LNG CARRIER OFFICER / GWANGY CONTRACT
NYK ANG
SHIPMANAG
EMENT PTE
LTD
TANGGUH BATUR / FIRST / / 17-10-2012 / 01-06- 07 M 20 D /
SINGAPORE / LNG OFFICER / UNKNOWN BITUNG 2013 / FINISHED
CARRIER NYK BITUNG CONTRACT
SHIPMANAG
EMENT PTE
LTD
TANGGUH BATUR / SECOND / / 12-12-2011 / 25-07- 07 M 15 D /
SINGAPORE / LNG OFFICER / UNKNOWN BITUNG 2012 / FINISHED
CARRIER NYK SHANGHA CONTRACT
SHIPMANAG I
EMENT PTE
LTD
TANGGUH TOWUTI SECOND / / 04-03-2011 / 22-09- 06 M 20 D /
/ SINGAPORE / OFFICER / UNKNOWN SINGAPORE 2011 / FINISHED
LNG CARRIER NYK GWANGY CONTRACT
SHIPMANAG ANG
EMENT PTE
LTD
TANGGUH TOWUTI SECOND / / 20-09-2010 / 06-12- 02 M 19 D /
/ SINGAPORE / OFFICER / UNKNOWN GWANGYANG 2010 / FINISHED
LNG CARRIER NYK BITUNG CONTRACT
SHIPMANAG
EMENT PTE
LTD
GRACE COSMOS / SECOND 100481 / 17-01-2010 / 13-06- 04 M 30 D /
BAHAMAS / LNG OFFICER / 39450 / MALTA 2010 / FINISHED
CARRIER/TRAININ GAZOCEAN UNKNOWN MEJILLON CONTRACT
G VESSEL ES
GRACE THIRD 100450 / 29-05-2009 / 27-09- 04 M 01 D /
BARLERIA / OFFICER / 39088 / KAWAGOE 2009 / FINISHED
BAHAMAS / LNG NYK LNG UNKNOWN KAWAGO CONTRACT
CARRIER Shipmanagem E
ent Ltd.
ECHIGO MARU / THIRD / / 13-12-2008 / 17-04- 04 M 08 D /
PANAMA / LNG OFFICER / UNKNOWN NIIGATA 2009 / FINISHED
CARRIER NYK NIIGATA CONTRACT
SHIPMANAG
 EMENT PTE
LTD
ECHIGO MARU / TRAINEE / / 15-07-2008 / 15-09- 02 M 04 D /
PANAMA / LNG THIRD UNKNOWN HIGASHI 2008 / COMPLETION OF
CARRIER OFFICER / OGISHIMA NIIGATA TRNG
NYK
SHIPMANAG
EMENT PTE
LTD
GAS BALI / THIRD / / 30-04-2007 / 18-03- 10 M 19 D /
UNKNOWN / OFFICER / UNKNOWN 2008 / FINISHED
LPG/CHEMICAL CONTRACT
TANKER
GAS SULAWESI / APPRENTICE / / 19-10-2006 / 21-04- 06 M 03 D /
UNKNOWN / THIRD UNKNOWN 2007 / FINISHED
LPG/CHEMICAL OFFICER / CONTRACT
TANKER
CORAL PALMATA / DECK CADET / / 16-09-2004 / 16-09- 12 M 01 D /
UNKNOWN / / UNKNOWN 2005 / FINISHED
LPG/CHEMICAL CONTRACT
TANKER

SHORE EXPERIENCE
COMPANY VESSEL RANK FROM DATE TO DATE PORT

LANGUAGE READ WRITE SPEAK