Form "A" File N° : DKT0l2021/JN116

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1•1•■;1◄111
DOCUMENT REVIEW Date: 09/12/2021
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COMPANY NAME PT. KUANTUM MARINA GLOBAL

(as to appear on certificate)
COMPANY ADDRESS Business Park Grand Galaxy City RRG Ill No. 96 Ke!. Jaka Setia Kee. Bekasi Selatan,
(as to appear on certificate) Kota Bekasi 17147 Jawa Barat - INDONESIA
+622182740854/ +62 813 1720 0419
COMPANY CONTACT

Standard Audit Co11ducted A2ainst Ot/1er Standards (e.g. ISO 900 I)

Approved Seafarer Manning Office Code -

AUDIT DATES From: 09/12/2021 To: 09/12/2021

LEAD AUDITOR Agus Suryantoro AUDITORSffRAINEES -

DOCUMENTATION
TITLE Date ofIssue Date oflatest Revision latest Revision Number

CompanyQSM 02/01/2018 - -
CBA 0l/07/2020 - -
SEA (Sampling) - - -

RULES, REGULATIONS, CODES, STANDARDS, GUIDELINES, observed during audit.

TJ1LE Revision# Revision Date

BVNE563 -• -
MLC2006 - -

AUDITOR'S Comments -
(continue on blank sheets ifrqrd)

Non-conformities raised ¥ES NO If Yes, are copies attached ¥ES NO

to Audit Report

Is Documentation complete to allow completion of audit? Yes Ne

SCOPE of AUDIT
(Delete as required)
Initial I PeFiedieal I Renewal I ,4dditienal

--�
•
Signature of Lead Auditor Signature of Client
,�
Name of Lead Auditor Agus Suryantoro Name of Client AKILPATil nRA�
KUANTUM MARINA GLOBAL

REV 1-07/18
 Form “B”
0B

File N°: DKT0/2021/JN116

1B AUDIT SUMMARY Date: 09/12/2021

COMPANY NAME PT. KUANTUM MARINA GLOBAL

(as to appear on certificate)
COMPANY ADDRESS Business Park Grand Galaxy City RRG III No. 96 Kel. Jaka Setia Kec. Bekasi Selatan, Kota
(as to appear on certificate) Bekasi 17147 Jawa Barat - INDONESIA
3B
DEPARTMENTS 2B

A B C D E F G H I J K
A 4B

No. Name
5B U
1 Agus Suryantoro D

MR Crewing
2 - I
3 - T

Director
4 - O
5 - R
S
NI 563 Month: DEC. 2021 Day by number: 10
Code Auditor as identified above
Ref. Period – 8 am / 5 pm
2.3 Application X
Management System Requirements X
3.1.1 Management Policy 5.1 X X
3.1.2 Management System 4.1 X X
3.1.3 Management System Review 5.6 X X
3.1.4 Internal Audits 8.2.2 X X
Organisation & Personnel X
3.2.1 Responsibility & Authority 5.5 X X
3.2.2 Management Representative 5.5.9 X X
3.2.3 Lines of Communication 5.5.10 X X
3.2.4 Training 6.0 X X
Documentation and Data Control X
3.3.1 System Procedures 4.2.3 X X
3.3.2 Document Control 4.2.3 X X
3.3.3 Records 4.2.4 X X
3.4.1 Contracts and the Review of Contracts 7.2 X X
3.4.2 Manning Contracts 7.5 X X
3.4.3 Crew Contracts 7.3 X X
3.4.4 Review of Contracts 7.2 X X
3.4.5 Amendments & Modifications to Con. 7.1 X X
3.4.6 Completion of Contracts 7.2 X X
3.4.7 Records 4.2.4 X X
3.5.1 Recruitment of Seafarers 7.0 X X
3.5.3 Evaluation of Sub-contractors 8.3 X X
3.6.1 Emergency Preparedness/COMPLAINS 8.0 X X
Special Comments by Auditor
A Akil Patinaran Director
B Rais Idris, S.SIT Pel MR/Crewing Manager
C Debby Chintya Finance Staff
D Irnawaty, S.Tr.Pel Crewing Staff

Referenced Documents Observed during Audit

6B

1 STCW 95 X X X
2 ISM Code
3 MLC 2006 X X X
4 Principles of Safe Manning
5 Others: BV NE 563 X X X

REV 2 – 07/2018
 Form “C” File N°: DKT0/2021/JN116

Date: 09/12/2021
AUDIT REPORT Page 1 of 4

COMPANY NAME
(as to appear on certificate) PT KUANTUM MARINA GLOBAL
COMPANY ADDRESS
(as to appear on certificate) Business Park Grand Galaxy City RRG III No. 96 Kel. Jaka Setia Kec. Bekasi Selatan,
Kota Bekasi 17147 Jawa Barat - INDONESIA
COMPANY CONTACT
+6221 82740854 / +62 813 1720 0419
Standard Audit Conducted Against Other Standards (e.g. ISO 9001)

Approved Seafarer Manning Office Code

AUDIT DATES From : 09/12/2021 To : 09/12/2021

LEAD AUDITOR Agus Suryantoro AUDITORS/TRAINEES -
Scope of Audit
(Any Change to the Company’s System must be recorded in this section)

Seafarer Manning Offices

Organisation of the Company

SUMMARY of NON-CONFORMITIES RAISED

(see Form F’s attached to Report)
Non-conformities Observations
Total : Total :
(List NCRs ref. # below) (List NCRs ref. # below)
-NONE- -NONE-

Name of Lead Auditor : Agus Suryantoro

Signature of Lead Auditor :

Date Report Signed : 09/12/2021

Check-List for the certification of Seafarer Manning Office’ Management Systems
and compliance with Bureau Veritas Guidance Note NI 563 and
ILO Convention MLC 2006 Regulation 1.4

1. General data:
 Public or Private SMO? PRIVATE
 Flag (s) Administration (s): Singapore
 Approximate number of seafarers in the pool at the audit date 8 Seafarers

SMO Management System Certification (Guidance Note NI 563)

ITEM Audit check List Y/N/ NC Evidences / Remarks

NA
Is the SMO Management System certified to any ISO
Y
standards or any similar quality standard ?
If Yes, is/are this/those certification(s) valid ?
Y
3.1.1 Does the SMO have a documented and implemented
Y QSM-5.1
Management Policy?
3.1.2 Does the SMO have a documented and implemented
Y QSM-4.1
Management System?
3.1.3 Is the SMO carrying out Management System Reviews at
Y QSM-5.6
defined intervals?
3.1.4.1 Is the SMO carrying out Internal Audits at defined intervals?
Y QSM-8.2.2
3.1.4.2 Is the SMO maintaining records of NC’s and subsequent
Y QSM-8.2.2
corrective actions?
3.2.1 Does the SMO have documented responsibilities and
Y QSM-5.5
authorities for personnel?
3.2.2 Does the Manning Office have a Management Representative
Y QSM-5.5.9
appointed and documented?
3.2.3 Does the SMO have clearly documented lines of
Y QSM-5.5.10
communication?
3.2.4 Does the SMO use approved/registered training facilities for
Y QSM-6.0
training of personnel?
3.3.1 Does the SMO have documented procedures for control of
Y QSM-4
activities relating to the Management System?
3.3.2 Does the SMO have documented procedures for control of
Y QSM-4.2.3
documents and data?
3.3.2 Are all valid documents available at relevant locations? Y QSM-4.2.3
3.3.2 Are all invalid/obsolete documents removed? Y QSM-4.2.3
3.3.2 Are all document changes approved and controlled? Y QSM-4.2.3
3.3.3.1 Are records maintained for management system functions?
Y QSM-4.2.4
3.3.3.2 Are records maintained for seafarers inc: qualifications,
Y QSM-4.2.4
medicals, appraisals, training, complaints, etc?
3.4.1 Does the SMO have documented procedures for contract
Y QSM-7.2
reviews?
3.4.2 Does the SMO have copies of manning contracts signed by
Y QSM-7.5
owner and the SMO?
3.4.3 Does the SMO have copies of the SEAs signed by the
Y QSM-7.3
Manning Office and seafarer?
3.4.4.1 Are the customer’s requirements clearly defined unambiguous
Y QSM-7.2
and documented ?
3.4.4.2 Are all appropriate and applicable laws, rules and regulatory
Y QSM-7.2
Authority requirements satisfied ?
3.4.4.3 Are records of contract reviews maintained?
Y QSM-7.2
3.4.5 Does the SMO have records of any amendments to
Y QSM-7.1
contracts?
3.5.1 Does the SMO have documented procedures for seafarer
Y QSM-7.2
recruitment?
3.5.3 Are subcontractors evaluated and records of such maintained,
N QSM-8.3
if any?
3.6.1 Does the SMO have a complaint procedure and records any
Y QSM-8.0
complaints raised?
MLC 2006 Compliance

MLC Standard A 1.4 – Recruitment and placement Y/N/ NC Evidences / Remarks

ITEM NA
2 Private SMO is operated in conformity with a standardized
Y
system of licensing or certification or similar
3 (a) The SMO is operated pursuant to a collective bargaining
Y Available in CBA
agreement between the SMO and a shipowner
3 (c) The Member State has national laws or regulations or a
procedure to authorize or register the collective bargaining Y Available in CBA
agreement permitting the operation of the SMO
3 (d) The SMO is operated in an orderly manner and measures are
Y Available in CBA
in place to protect and promote seafarers’ employment rights
5 (a) The SMO does not use means, mechanisms or lists intended
to prevent or deter seafarers from gaining employment for Y Available in CBA
which they are qualified
5 (b) The SMO confirms that no fees or other charges for seafarer
recruitment or placement or for providing employment to Sampling Crew Documents Certificates, sampling
seafarers are borne directly or indirectly, in whole or in part, Y Seafarer Medical Certificates and sampling SEA
by the seafarer. The cost of visas shall be borne by the verified
shipowner
5(c) (i) The SMO maintains an up-to-date register of all seafarers List of register of all seafarers recruited and
recruited or placed through them, to be available for Y placed, seafarer CV and seafarer certificates
inspection by the competent authority verified
5(c) (ii) The SMO makes sure that seafarers are informed of their
rights and duties under their employment agreements prior to
or in the process of engagement and that proper
Y Available in CBA and SEA
arrangements are made for seafarers to examine their
employment agreements (SEA) before and after they are
signed and for them to receive a copy of the agreements
5 (c) (iii) The SMO verifies that seafarers recruited or placed by them
are qualified and hold the documents necessary for the job
concerned, and that the seafarers’ employment agreements
Y Available in CBA and SEA
are in accordance with the applicable laws and regulations
and any collective bargaining agreement that forms part of the
employment agreement
5 (c) (iv) The SMO makes sure, as far as practicable, that the
shipowner has the means to protect seafarers from being Y Available in CBA and SEA
stranded in a foreign port
5 (c) (v) The SMO shall examine and respond to any complaint
concerning their activities and advise the competent authority Y Available in CBA and SEA
of any unresolved complaint
5 (c) (vi) The SMO has established a system of protection, by way of
insurance or an equivalent appropriate measure, to
compensate seafarers for monetary loss that they may incur
as a result of the failure of the SMO or the relevant shipowner Y Available in CBA and SEA
under the seafarers’ employment agreement to meet its
obligations to them

Guideline B 1.4.1 – Organizational and operational guidelines.

The SMO shall develop and maintain verifiable operational practices which shall address:
2 (a) Medical examinations, seafarers’ identity documents and such
Sampling Crew Documents Certificates, sampling
other items as may be required for the seafarer to gain
Y Seafarer Medical Certificates and sampling SEA
employment
verified
3 (b) Maintaining, with due regard to the right to privacy and the
need to protect confidentiality, full and complete records of the
seafarers covered by their quality management system, which
Y Seafarer CV and certificates verified
should include but not limited to: the seafarers’ qualification;
record of employment; personal data relevant to employment
and medical data relevant to employment
3 (c) Maintaining up-to-date lists of the ships for which the SMO
Lists of the ships for which the SMO provide
provide seafarers and ensuring that there is a means by Y
seafarers verified
which the SMO can be contacted in an emergency at all hours
3 (d) Procedures to ensure that seafarers are not subject to
exploitation by the SMO or their personnel with regard to the
Y Provided in CBA, SE and Company QSM
offer of engagement on particular ships or by particular
companies
3 (e) Procedures to prevent the opportunities for exploitation of
seafarers arising from the issue of joining advances or any
Y Provided in CBA, SE and Company QSM
other financial transaction between the shipowner and the
seafarers which are handled by the SMO
3 (f) Clearly publicizing costs, if any, which the seafarer will be
Y Verified and confirmed
expected to bear in the recruitment process
3 (g) Ensuring that seafarers are advised of any particular
conditions applicable to the job for which they are to be Available on Crew Management Procedure on
Y
engaged and of the particular shipowner’s policies relating to 6.2.1 Pre Departure Formalities Procedure
their employment
3 (h) Procedures which are in accordance with the principles of
natural justice for dealing with cases of incompetence or Complaint Procedure, refer to complaint
Y
indiscipline consistent with national laws and practice and, Procedure. Attached the forms.
where applicable, with collective agreements
3 (i) Procedures to ensure, as far as practicable, that all
mandatory certificates and documents submitted for Available on Crew Management Procedure as
Y
employment are up to date and have not been fraudulently Attached a on 6.1 Scheduling and Crew Reporting.
obtained and that employment references are verified
3 (j) Procedures to ensure that requests for information or advice
Available on Seafarers Contingency Procedure at
by families of seafarers while the seafarers are at sea are Y
General Contingency procedure 6.2 as attached
dealt with promptly and sympathetically and at no cost
3 (k) Verifying that labour conditions on ships where seafarers are
placed are in conformity with applicable collective bargaining
agreements concluded between a shipowner and a Available on Quality Manual at QSM 7.5
representative seafarers’ organization and, as a matter of Y MANNING AND SERVICE PROVISION and
policy, supplying seafarers only to shipowners that offer terms Business code of conduct as attached
and conditions of employment to seafarers which comply with
applicable laws or regulations or collective agreements

2. Non-Conformities
NC Description
No

3 Remarks:

4 Attachments:
Page 4/4
 Form "D" File N° : DKT0/2021/JNl 16

AUDIT PLAN Date: 09/12/2021

COMPANY PT. KUANTUM MARINA GLOBAL

(as to appear on certificate)
COMPANY ADDRESS Business Park Grand Galaxy City RRG III No. 96 Ke!. Jaka Selia Kee. Bekasi Selatan,
Kota Bekasi 17147 Jawa Barat- INDONESIA
(as to appear on certificate)

Note : Create Additional Sheets as necessary

Date Time AUDIT PLAN Participants
From To

09/12/2021 09.00 Opening Meeting 1. Agus Suryantoro

2. Aki/ Patinaran
3. Rais Idris, S.S/T Pel
4. Debby Chintya
5. lmawaty, S. Tr.Pel

Revie-.v Document 1. Aki/ Patinaran

2. Rais Idris, S.S/T Pel
3. Debby Chintya
4. lmawaty, S. Tr.Pel

Interview 1. Aki/ Patinaran

2. Rais Idris, S.SIT Pel
3. Debby Chintya
4. lmawaty, S. Tr.Pel

09/12/2021 17.00 Closing Meeting 1. Agus Suryantoro

2. Aki/ Patinaran
3. Rais Idris, S.S/T Pel
4. Debby Chintya
5. lmawaty, S. Tr.Pel

Opening Meeting - Persons Present Closing Meeting - Persons Present

Name Position Held Name Position Held
1. Agus Suryantoro Auditor (BV) 1. Agus Suryantoro Auditor (BV)

�
2. Aki/ Patinaran Director 2 Aki/ Patinaran Director

3. Rais Idris, S.SIT Pel MR/Crewing Manager 3. Rais Idris, S.Sff Pel (i MR/Crewing Manager

," ' II • J
4. Debby Chintya •= I
-v11,...__,. 1> H Finance Staff 4. Debby Chintya ,?'lll--�!1/
',,
1 . Finance Staff
I
5. tmawaly, S. T,Pet �� Crewing Staff 5. lmawaty, S. Tr.Pel j 1J .,,..,.-� Crewing Staff
�f\.Ul)j
.,-

REV O - 12/07/2009
 Form “F” 0B
File N°: DKT0/2021/JN116

NON-CONFORMITY
1B

Date: 09/12/2021
REPORT
The Company should note that the audit is based upon a sampling process.
The identification of this non-conformity does not imply that others do not exist.

COMPANY NAME : PT. KUANTUM MARINA GLOBAL NC (consecutive number)

NI 563 Ref.: Non-conformity Observation

(delete the inappropriate)
-NONE-
Area / Dept.:

Lead Auditor initials:

Company Representative
initials:

AUDITOR’S COMMENTS

-NONE-

PROPOSED COMPLETION DATE ACTUAL COMPLETION DATE

PROPOSED CORRECTIVE ACTION (This must include curative and preventive action)

Signature of Company Rep.:

PROPOSED ACTIONS ACCEPTED : YES / NA / NO (delete the inappropriate)

COMMENTS :

Signature :

Auditor Clearing NC : Date : Name :

COMMENTS :

Signature :