Scribd
Upload
1K views4 pages

Crew List: Form 22 Immigration Act (CHAPTER 133)

The document is a crew list for the vessel AHTS KATALINA containing 16 crew members. It lists the crew members' names, sexes, dates of birth, nationalities, travel document numbers, dates their travel documents expire, and duties on board. It also lists the vessel's last port of Lamongan, next port of Cirebon, owner as PT. Baruna Raya Logistik, and agent in port as PT. Zio Jaya Bahari.

Uploaded by

Agoes Tjirebon
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
1K views4 pages

Crew List: Form 22 Immigration Act (CHAPTER 133)

The document is a crew list for the vessel AHTS KATALINA containing 16 crew members. It lists the crew members' names, sexes, dates of birth, nationalities, travel document numbers, dates their travel documents expire, and duties on board. It also lists the vessel's last port of Lamongan, next port of Cirebon, owner as PT. Baruna Raya Logistik, and agent in port as PT. Zio Jaya Bahari.

Uploaded by

Agoes Tjirebon
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
You are on page 1/ 4

Form 22

IMMIGRATION ACT
(CHAPTER 133)

IMMIGRATION REGULATIONS
CREW LIST

Name of Vessel / Nama Kapal : AHTS KATALINA


Gross Tonage / GT Kapal : 1674 TON
Agent in Port / Keagenan PT. ZIO JAYA BAHARI
Owner's / Pemilik : PT. BARUNA RAYA LOGISTIC
Date Of Arrival / Tanggal Tiba : 24-03-2021
Date Of Departure / Tanggal Berangkat : 27-03-2021

No. Name / Nama Awak Sex / Date of Birth / Nationality /


Tanggal Lahir Kebangsaan
1 ERI SANTOSO M INDONESIA
2 BUDI PRATIKNO M 2-May-1975 INDONESIA
3 SYAIFULLAH AL HANIF M 21-Oct-1990 INDONESIA
4 BUDI UNTORO M 21-Apr-1976 INDONESIA
5 MUKHTAR BAHARUDIN M 24-Mar-1981 INDONESIA
6 RUSDIANTO M 27-Mar-1982 INDONESIA
7 RIDWAN ABDUL RAHIM M 2-May-1975 INDONESIA
8 DEVY ERWIN NENDISSA M 12-Dec-1975 INDONESIA
9 DADANG M 29-May-1999 INDONESIA
10 ARIEF JUNAIDI M 23-Jun-1975 INDONESIA
11 MARKUS RASI M 7-Jul-1975 INDONESIA
12 HASRIADI M 25-Mar-1984 INDONESIA
13 NANANG RUKMANA M 23-Jun-1975 INDONESIA
14 ASEP SOLEH HAMBALI M 7-Jul-1975 INDONESIA
15 SYAHRUL HASNAM M 29-May-1999 INDONESIA
16 AL MUHDAR M 19-Nov-1997 INDONESIA
Total Crews / Total Awak : Person included master.

Acknowledge
Harbour Master
Form 22
MMIGRATION ACT
(CHAPTER 133)

ATION REGULATIONS
CREW LIST

Last Port / Pelabuhan Sebelumnya : LAMONGAN


Next Port / Pelabuhan Selanjutnya : CIREBON

Travel Document No. / Doc.Of Travel Expired / Duties on Board /


No. Buku Pelaut Tanggal Berakhir Buku Pelaut Jabatan
F 129533 6-Apr-2022 NAKHODA
E 024883 21-Oct-2022 MUALIM I
F 117914 2-Mar-2023 MUALIM II
D 070657 29-Jul-2022 KKM
F 001272 26-Apr-2022 MASINIS I
F 099033 26-Feb-2023 MASINIS II
E 046199 5-Jan-2023 BOSUN
F 183463 22-Oct-2022 JURU MUDI
E 062798 3-May-2023 JURU MUDI
E 046441 6-Jan-2023 JURU MUDI
G 017272 2-Oct-2023 OILER
F 183570 21-Nov-2022 OILER
E 036341 18-Jan-2023 COOK
D 084880 9-Jun-2023 COOK
F 327046 13-Mar-2023 CADET DECK
F 302762 26-Nov-2022 CADET ENGINE
________________, Year

Manager

You might also like