1 MSTR GIM YEONGIL Korean 20-Aug-48 BUSAN 07-Dec-11 Kota Kinabalu BS114-00900 Unlimited M78858943 4-Feb-14

2 C/O JEONG YEONG SEOK Korean 21/Jan/86 BUSAN 1/Jul/11 Sapangar Bay BS038-00761 Unlimited M45812864 3/Apr/14

3 2/OA WIDI HERMAWAN INDONESIA 13-Jul-80 BANGKALAN 24-Dec-11 SINGAPORE W017298 30-Jan-14 A1602581 15-Nov-16

4 2/OB SAHIRUDIN OKTAVIA INDONESIA 3-Oct-83 JAKARTA 26-Nov-11 X084299 20-Oct-13 R726967 3-Apr-13
SINGAPORE
5 3/O RIKO HERDIYANTO INDONESIA 11-Aug-87 INDRAMAYU 27-Nov-11 T051455 24-May-14 P520287 13-Jun-12
SINGAPORE
6 C/E JO SUNG DU Korean 29-Jan-54 BUSAN 1-Oct-11 KS791-18145 Unlimited M00573188 24-Sep-18
SINGAPORE
7 1//E SIN SEONG GIL Korean 3-Apr-63 BUSAN 11-Oct-11 Sapangar Bay BS084-04265 Unlimited M06938443 13-Apr-19

8 2/E MUHAMMAD ISMAIL MARZUQI INDONESIA 13-Apr-82 PATI 1-Oct-11 X024933 24-Mar-13 R680146 26-Mar-13
SINGAPORE
9 2/EB NARDO HANDONO INDONESIA 13-Mar-85 PEKALONGAN 14-Jul-11 R067573 6-Jul-12 V020483 7-May-15
SINGAPORE
10 3/E SISWANTO BIN SUPRAPTO INDONESIA 28-Mar-84 TEMANGGUNG 24-Dec-11 SINGAPORE R067564 6-Jul-12 U018181 12-Oct-14

11 BSN SUKODO INDONESIA 19-Jan-65 JAKARTA 23-Aug-11 V071016 20-Jun-13 V749272 20-Jul-15
SINGAPORE
12 ABA BAHARUDDIN INDONESIA 15-Dec-73 TAMARA 14-Jul-11 W004528 4-Dec-13 U907453 12-Apr-15
SINGAPORE
13 ABB EDI HARIANTO INDONESIA 15-Jan-78 SURABAYA 13-Nov-11 W049075 23-Jun-14 T122256 7-Apr-14
SINGAPORE
14 ABC ABDUL JALIL INDONESIA 2-May-76 BANGKALAN 13-Nov-11 X061182 25-Jul-13 U017861 8-Oct-14
SINGAPORE
15 O/S FIRMAN INDONESIA 12-Oct-86 BENTENG 1-Oct-11 Y075036 29-Sep-14 U018933 19-Oct-14
SINGAPORE
16 OLR 1 SUJATMAN INDONESIA 4-Apr-65 PURWODADI 24-Dec-11 SINGAPORE X038891 16-May-13 A1452031 11-Oct-16

17 OLR 2 BANDAR PARNINGOTAN PARDOSI INDONESIA 17-Apr-71 PARSOBURAN 29-May-11 V023263 12-Dec-12 S886435 29-Jan-14
SINGAPORE
18 OLR 3 KIRAMAN INDONESIA PALOPO 23-Aug-11 S058993 31-Aug-13 S888658 19-Feb-14
31-Dec-77 SINGAPORE
19 C/CK KARLAN INDONESIA PURWOKERTO 29-Jul-11 X044639 25-May-13 T800219 25-May-15
21-Jun-58 SINGAPORE
20 M/M MAIL JAYA INDONESIA PALOPO 18-Jun-11 T051271 13-May-14 A0706926 15-Jun-16
5-May-75 SINGAPORE
 Vessel: M/T PIONEER SPIRIT
Q88.COM OFFICER MATRIX QUESTIONAIRE Date : 9-Jul-24

Deck Officer-Rank MASTER C/O 2/O A 2/O B 3/O

Name GIM YEONGIL JEONG YEONG SEOK AHMAD EFENDI SAHIRUDIN OKTAVIA RIKO HERDIYANTO

Nationality Korean Korean INDONESIA INDONESIA INDONESIA

Certificate of Competency MASTER -CLASS 1 C/O-CLASS 2 2ND-CLASS 3 2ND-CLASS 2 3RD-CLASS 3
Issuing Country Korea Korea INDONESIA INDONESIA INDONESIA
Adminstration Acceptance Yes Yes Yes Yes Yes
Tanker certification (O C G) Oil, Chemical Oil, Chemical Oil, Chemical Oil, Chemical Oil, Chemical
STCW V papra 1 or 2 for current
2 2 2 2
cargo
Radio Qualification (GMDSS) GOC GOC GOC GOC GOC
Years with Company 5 1.8 0.4 3 1
Years in Rank 25 1.7 4 3 2
Years on this type of Tanker 25 7 4 4 2
Years on all types of Tanker 30 7 4 4 2
Months on this vessel this tour of duty 152 157 157 152 152
Proficient in English GOOD GOOD GOOD GOOD GOOD
Deck Officer-Rank Chief Engineer 1/AE 2 A/E 2 B/E 3 A/E
MUHAMMAD ISMAIL
Name JO SUNG DU SIN SEONG GIL
MARZUQI
NARDO HANDONO SATRIYONO ANDI NUSANTARA

Nationality korean korean INDONESIA INDONESIA INDONESIA

Certificate of Competency C/E -CLASS 1 1ST ENGR-CLASS 2 2ND ENGR-CLASS 3 2ND ENGR-CLASS 3 2ND ENGR-CLASS 3
Issuing Country korean korean INDONESIA INDONESIA INDONESIA
Adminstration Acceptance Yes Yes Yes Yes Yes
Tanker certification (O C G) Oil, Chemical Oil, Chemical Oil, Chemical Oil, Chemical Oil, Chemical
STCW V papra 1 or 2 for current
2 2 2 2 2
cargo
Radio Qualification (GMDSS) N/A N/A N/A N/A N/A
Years with Company 4.8 0.1 1.4 2.2 0.4
Years in Rank 2 7 1.2 2 1
Years on this type of Tanker 7 7 2 2 1
Years on all types of Tanker 7 8 3 4 1
Months on this vessel this tour of duty 154 153 154 156 156
Proficient in English GOOD GOOD GOOD GOOD GOOD
 KT MARINE CO., LTD KT MARINE CO., LTD
No 1 2
S H I P M/T BOW PLATA S H I P M/T BOW PLATA
R A N K MSTR R A N K C/O
N A M E GIM YEONGIL N A M E JEONG YEONG SEOK
NATIONALTY Korean NATIONALTY Korean
B I R T H 20-Aug-48 B I R T H 21-Jan-86

KT MARINE CO., LTD KT MARINE CO., LTD

No 3 4
S H I P M/T BOW PLATA S H I P M/T BOW PLATA
R A N K 2/OA R A N K 2/OB
N A M E WIDI HERMAWAN N A M E SAHIRUDIN OKTAVIA
NATIONALTY INDONESIA NATIONALTY INDONESIA
B I R T H 13-Jul-80 B I R T H 3-Oct-83

KT MARINE CO., LTD KT MARINE CO., LTD

No 5 6
S H I P M/T BOW PLATA S H I P M/T BOW PLATA
R A N K 3/O R A N K C/E
N A M E RIKO HERDIYANTO N A M E JO SUNG DU
NATIONALTY INDONESIA NATIONALTY Korean
B I R T H 11-Aug-87 B I R T H 29-Jan-54
 KT MARINE CO., LTD KT MARINE CO., LTD
No 7 8
S H I P M/T BOW PLATA S H I P M/T BOW PLATA
R A N K 1//E R A N K 2/E
N A M E SIN SEONG GIL N A M E MUHAMMAD ISMAIL MARZUQI
NATIONALTY Korean NATIONALTY INDONESIA
B I R T H 3-Apr-63 B I R T H 13-Apr-82

KT MARINE CO., LTD KT MARINE CO., LTD

No 9 10
S H I P M/T BOW PLATA S H I P M/T BOW PLATA
R A N K 2/EB R A N K 3/E
N A M E NARDO HANDONO N A M E SISWANTO BIN SUPRAPTO
NATIONALTY INDONESIA NATIONALTY INDONESIA
B I R T H 13-Mar-85 B I R T H 28-Mar-84

KT MARINE CO., LTD KT MARINE CO., LTD

No 11 12
S H I P M/T BOW PLATA S H I P M/T BOW PLATA
R A N K BSN R A N K ABA
N A M E SUKODO N A M E BAHARUDDIN
NATIONALTY INDONESIA NATIONALTY INDONESIA
B I R T H 19-Jan-65 B I R T H 15-Dec-73
 KT MARINE CO., LTD KT MARINE CO., LTD
No 13 14
S H I P M/T BOW PLATA S H I P M/T BOW PLATA
R A N K ABB R A N K ABC
N A M E EDI HARIANTO N A M E ABDUL JALIL
NATIONALTY INDONESIA NATIONALTY INDONESIA
B I R T H 15-Jan-78 B I R T H 2-May-76

KT MARINE CO., LTD KT MARINE CO., LTD

No 15 16
S H I P M/T BOW PLATA S H I P M/T BOW PLATA
R A N K O/S R A N K OLR 1
N A M E FIRMAN N A M E SUJATMAN
NATIONALTY INDONESIA NATIONALTY INDONESIA
B I R T H 12-Oct-86 B I R T H 4-Apr-65

KT MARINE CO., LTD KT MARINE CO., LTD

No 17 18
S H I P M/T BOW PLATA S H I P M/T BOW PLATA
R A N K OLR 2 R A N K OLR 3
N A M E BANDAR PARNINGOTAN PARDOSI N A M E KIRAMAN
NATIONALTY INDONESIA NATIONALTY INDONESIA
B I R T H 17-Apr-71 B I R T H 31-Dec-77
 KT MARINE CO., LTD KT MARINE CO., LTD
No 19 20
S H I P M/T BOW PLATA S H I P M/T BOW PLATA
R A N K C/CK R A N K M/M
N A M E KARLAN N A M E MAIL JAYA
NATIONALTY INDONESIA NATIONALTY INDONESIA
B I R T H 21-Jun-58 B I R T H 5-May-75

KT MARINE CO., LTD KT MARINE CO., LTD

No 21 22
S H I P M/T BOW PLATA S H I P M/T BOW PLATA
R A N K 0 R A N K Err:502
N A M E 0 N A M E

NATIONALTY 0 NATIONALTY 0
B I R T H 30-Dec-99 B I R T H 30-Dec-99

KT MARINE CO., LTD KT MARINE CO., LTD

M/T BOW PLATA M/T BOW PLATA

1 VISITOR'S PASS
2 VISITOR'S PASS
 KT MARINE CO., LTD KT MARINE CO., LTD
M/T BOW PLATA M/T BOW PLATA

3 VISITOR'S PASS
4 VISITOR'S PASS

KT MARINE CO., LTD KT MARINE CO., LTD

M/T BOW PLATA M/T BOW PLATA

5 VISITOR'S PASS
6 VISITOR'S PASS

KT MARINE CO., LTD KT MARINE CO., LTD

M/T BOW PLATA M/T BOW PLATA

7 VISITOR'S PASS
8 VISITOR'S PASS
 KT MARINE CO., LTD KT MARINE CO., LTD
M/T BOW PLATA M/T BOW PLATA

9 VISITOR'S PASS
10 VISITOR'S PASS

KT MARINE CO., LTD KT MARINE CO., LTD

M/T BOW PLATA M/T BOW PLATA

11 VISITOR'S PASS
12 VISITOR'S PASS

KT MARINE CO., LTD KT MARINE CO., LTD

M/T BOW PLATA M/T BOW PLATA

13 VISITOR'S PASS
14 VISITOR'S PASS
Ship'name PIONEER SPIRI CREW'S CERTIFICATE STATUS 9-Jul-24

Passport Seaman book Panama Panma Oil Chemical General Ship Medical CHEMICAL
No Crew Name Rank BRTM ECDIS Security
Expory Expiry Cert Expiry Gmdss Endorcement Endorcement Tanker handling care TEST

1 GIM YEONGIL MSTR 4-Feb-14 Unlimited CT 858662 17-Dec-12 17-Dec-12 CTB 858647 24-Nov-15 24-Nov-15 OK OK OK OK OK OK

2 JEONG YEONG SEOK C/O 03-Apr-14 Unlimited CTB196745 28-Apr-14 4-Aug-14 CTB252717 19-Jul-15 19-Jul-15 OK OK OK OK OK OK

3 WIDI HERMAWAN 2/OA 15-Nov-16 30-Jan-14 CTB 180807 09-May-13 12-May-13 CTB 180808 10-Feb-12 25-Apr-13 OK OK OK OK OK OK

4 SAHIRUDIN OKTAVIA 2/OB 03-Apr-13 20-Oct-13 0048285-C 25-Feb-12 4-Dec-12 CTB 32254 1-Nov-15 1-Nov-15 OK N/A OK OK AID OK

5 RIKO HERDIYANTO 3/O 13-Jun-12 24-May-14 CTB 422078 25-Feb-15 7-Aug-14 CTB 422079 22-Feb-15 22-Feb-15 OK N/A OK OK OK OK

6 JO SUNG DU C/E 24-Sep-18 Unlimited CT982910 16-Jul-13 3-Nov-13 3-Nov-13

7 SIN SEONG GIL 1//E 13-Apr-19 Unlimited CTB552797 12-Jul-16 26-Mar-13 10-Oct-16
8 MUHAMMAD ISMAIL MARZUQI 2/E 26-Mar-13 24-Mar-13 CTB 380363 10-Jun-15 21-Dec-14 21-Dec-14

9 NARDO HANDONO 2/EB 07-May-15 06-Jul-12 CTB 99832 02-May-13 14-Aug-12

10 SISWANTO BIN SUPRAPTO 3/E 12-Oct-14 06-Jul-12 CTB 421423 22-Jun-14 20-Aug-13 25-Jul-14

11 SUKODO BSN 20-Jul-15 20-Jun-13 CTB 118228 11-Dec-13 21-Jan-13

12 BAHARUDDIN ABA 12-Apr-15 04-Dec-13 CTB 031550 05-Mar-13 14-Jan-13

13 EDI HARIANTO ABB 07-Apr-14 23-Jun-14 CTB 030858 13-Feb-13 26-Apr-15

14 ABDUL JALIL ABC 08-Oct-14 25-Jul-13 CTB 802346 10-Jun-12 4-Feb-12

15 FIRMAN O/S 19-Oct-14 29-Sep-14 CTB 421411 15-Jun-16 26-Oct-14

16 SUJATMAN OLR 1 11-Oct-16 16-May-13 CT 801904 09-May-12 12-Jan-14

17 BANDAR PARNINGOTAN PARDOSI OLR 2 29-Jan-14 12-Dec-12 CT 421296 26-May-16 8-Mar-15

18 KIRAMAN OLR 3 19-Feb-14 31-Aug-13 CTB 030862 13-Feb-13 14-Jan-13

19 KARLAN C/CK 25-May-15 25-May-13 CTB 033745 21-May-13 15-May-15

20 MAIL JAYA M/M 15-Jun-16 13-May-14 CT 801895 29-May-12 09-Jan-14

60 DAYS OVER VALID

1-60 DAYS VALID WARNING
EXPIRED AND NILL WARNING MASTER OF M/T PIONEER SPIRIT
 PASSENGER LIST
Arrival ✘ Deaprture ✘

1 . Name of Vessel 2. Port of arrival* / depsrture * 3. Date of Arrival */ departure*

M/T LAUREL GALAXY 23-Sep-09

4. Nationality 5. Port arrived from *

7. Nature and No. of identity
PANAMA

9. Rank Document
(Passport) SIGN-ON EMBAKED
7. N 8. Family name , given names and 10.Nationality11. Date ans place of birth* EXPIRY
DATE PLACE
Rating

01

02

03

04

05

06

07

08

09

Master of M/T LAUREL GALAXY

 CREW LIST
1
Arrival ✘ Deaprture Arrival
✘
.
1 . Name of Vessel 2. Port of arrival* / departure * 3. Date of Arrival */ departure*
4
M/T PIONEER SPIRIT .M/T G

4. Nationality 5. Port arrived from * 7. Nature and No. of identity N

PANAMA
Document
9. Rank Document (Passport) SIGN-ON EMBAKED
8. Family name , given names and 10.Nationality 11. Date ans place of bir (Seamen's Expiry EXPIRY
DATE PLACE
Rating Book)

BS114-
1 GIM YEONGIL MSTR Korean 20-Aug-48 BUSAN Permenent M78858943 4-Feb-14 07-Dec-11 Kota Kinabalu
00900
BS038-
2 JEONG YEONG SEOK C/O Korean 21-Jan-86 BUSAN Permenent M45812864 03-Apr-14 1-Jul-11 Sapangar Bay
00761
BANGKAL
3 WIDI HERMAWAN 2/OA INDONESIA13-Jul-80 AN
W017298 Permenent A1602581 15-Nov-16 24-Dec-11 SINGAPORE

4 SAHIRUDIN OKTAVIA 2/OB INDONESIA3-Oct-83 JAKARTA X084299 Permenent R726967 03-Apr-13 26-Nov-11 SINGAPORE

INDRAMA
5 RIKO HERDIYANTO 3/O INDONESIA11-Aug-87 YU T051455 Permenent P520287 13-Jun-12 27-Nov-11 SINGAPORE

KS791-
6 JO SUNG DU C/E Korean 29-Jan-54 BUSAN Permenent M00573188 24-Sep-18 1-Oct-11 SINGAPORE
18145
BS084-
7 SIN SEONG GIL 1//E Korean 3-Apr-63 BUSAN Permenent M06938443 13-Apr-19 11-Oct-11 Sapangar Bay
04265
MUHAMMAD ISMAIL
8 2/E INDONESIA13-Apr-82 PATI X024933 Permenent R680146 26-Mar-13 1-Oct-11 SINGAPORE
MARZUQI
PEKALON
9 NARDO HANDONO 2/EB INDONESIA13-Mar-85 GAN R067573 Permenent V020483 07-May-15 14-Jul-11 SINGAPORE

SISWANTO BIN TEMANG

10 3/E INDONESIA28-Mar-84 GUNG R067564 Permenent U018181 12-Oct-14 24-Dec-11 SINGAPORE
SUPRAPTO

11 SUKODO BSN INDONESIA19-Jan-65 JAKARTA V071016 Permenent V749272 20-Jul-15 23-Aug-11 SINGAPORE

12 BAHARUDDIN ABA INDONESIA15-Dec-73 TAMARA W004528 Permenent U907453 12-Apr-15 14-Jul-11 SINGAPORE

SURABAY
13 EDI HARIANTO ABB INDONESIA15-Jan-78 A
W049075 Permenent T122256 07-Apr-14 13-Nov-11 SINGAPORE

BANGKAL
14 ABDUL JALIL ABC INDONESIA2-May-76 AN
X061182 Permenent U017861 08-Oct-14 13-Nov-11 SINGAPORE

15 FIRMAN O/S INDONESIA12-Oct-86 BENTENG Y075036 Permenent U018933 19-Oct-14 1-Oct-11 SINGAPORE

PURWOD
16 SUJATMAN OLR 1 INDONESIA4-Apr-65 ADI
X038891 Permenent A1452031 11-Oct-16 24-Dec-11 SINGAPORE

BANDAR PARNINGOTAN PARSOBU

17 OLR 2 INDONESIA17-Apr-71 RAN V023263 Permenent S886435 29-Jan-14 29-May-11 SINGAPORE
PARDOSI

18 KIRAMAN OLR 3 INDONESIA31-Dec-77 PALOPO S058993 Permenent S888658 19-Feb-14 23-Aug-11 SINGAPORE

PURWOKE
19 KARLAN C/CK INDONESIA21-Jun-58 RTO
X044639 Permenent T800219 25-May-15 29-Jul-11 SINGAPORE

20 MAIL JAYA M/M INDONESIA5-May-75 PALOPO T051271 Permenent A0706926 15-Jun-16 18-Jun-11 SINGAPORE

12. Date and signature by master, authorized agent officer

Note It is not necessary to fill in item marked "*"
TOTAL 20
 선 원 명 부
✘ 입항 출항

1. 선박명 Name of ship 3. 당해년도 입항횟수 4. 출.입항 년월일

M/T PIONEER SPIRIT 2 12/3/2010
10. 선원.여권 12. 주소
5.순번 6. 직명 7. 성명 8. 생년월일 9. 국적
11.승선지/승선일 (한국인경우 기재)
MSTR 20-Aug-48 M78858943
1 GIM YEONGIL Korean 한국인
1106116 Kota Kinabalu 07-Dec-11
C/O 860121 / M45812864
2 JEONG YEONG SEOK Korean 한국인
1841413 Sapangar Bay 01-Jul-11
2/OA A1602581
3 WIDI HERMAWAN 13-Jul-80 Myanmar 외국인
SINGAPORE 24-Dec-11
2/OB R726967
4 SAHIRUDIN OKTAVIA 3-Oct-83 Myanmar 외국인
SINGAPORE 26-Nov-11
3/O P520287
5 RIKO HERDIYANTO 11-Aug-87 Myanmar 외국인
SINGAPORE 27-Nov-11
C/E 540129 / M00573188
6 JO SUNG DU Korean 한국인
1119839 SINGAPORE 01-Oct-11
1//E M06938443
7 SIN SEONG GIL 3-Apr-63 Indonesia 외국인
Sapangar Bay 11-Oct-11
2/E R680146
8 MUHAMMAD ISMAIL MARZUQI 13-Apr-82 Myanmar 외국인
SINGAPORE 01-Oct-11
2/EB V020483
8 NARDO HANDONO 13-Mar-85 Myanmar 외국인
SINGAPORE 14-Jul-11
3/E U018181
10 SISWANTO BIN SUPRAPTO 28-Mar-84 Myanmar 외국인
SINGAPORE 24-Dec-11
BSN V749272
11 SUKODO 0 19-Jan-65 Myanmar 외국인
SINGAPORE 23-Aug-11
ABA U907453
12 BAHARUDDIN0 15-Dec-73 Myanmar 외국인
SINGAPORE 14-Jul-11
ABB T122256
13 EDI HARIANTO 15-Jan-78 Myanmar 외국인
SINGAPORE 13-Nov-11
ABC U017861
14 ABDUL JALIL 2-May-76 Myanmar 외국인
SINGAPORE 13-Nov-11
O/S 861012 / U018933
15 FIRMAN0 Korean 한국인
1284514 SINGAPORE 01-Oct-11
OLR 1 A1452031
16 SUJATMAN 0 4-Apr-65 Myanmar 외국인
SINGAPORE 24-Dec-11
OLR 2 S886435
18 BANDAR PARNINGOTAN PARDOS17-Apr-71 Myanmar 외국인
SINGAPORE 29-May-11
OLR 3 S888658
18 KIRAMAN0 31-Dec-77 Myanmar 외국인
SINGAPORE 23-Aug-11
C/CK 580621 / T800219
19 KARLAN0 Korean 한국인
1121626 SINGAPORE 29-Jul-11
M/M A0706926
20 MAIL JAYA 5-May-75 Myanmar 외국인
SINGAPORE 18-Jun-11
0 0
21 00 30-Dec-99 Myanmar 외국인
30-Dec-99 30-Dec-99

22

23

korean 1
Filipno 21
Total: 22 crew
CALL SIGN : 3FAG8 FORM 22
TYPE : CHEMICAL TANKER IMMIGRATION ACT
FLAG : PANAMA (CHAPTER 133)
GRT : 5,340.00 ton
NRT : 2,635.00 ton IMMIGRATION REGULATIONS
LOC CREWLIST
PIC
TEL
NAME OF VESSEL : M/T PIONEER SPIRIT MASTER/OWNER/CHARTERER :
AGENTS IN SINGAPORE :
LAST PLACE OF EMBARKATION DATE OF ARRIVAL :
NEXT DESTINATION : DATE OF DEPARTURE :
Travel Expiry Date
Date of Duties on
No Name Sex Nationality Document of Travel
Birth Board
No. Document

1 GIM YEONGIL M 20-Aug-48 Korean M78858943 4-Feb-14 MSTR

2 JEONG YEONG SEOK M 21-Jan-86 Korean M45812864 3-Apr-14 C/O

3 WIDI HERMAWAN M 13-Jul-80 INDONESIA A1602581 15-Nov-16 2/OA

4 SAHIRUDIN OKTAVIA M 03-Oct-83 INDONESIA R726967 3-Apr-13 2/OB

5 RIKO HERDIYANTO M 11-Aug-87 INDONESIA P520287 13-Jun-12 3/O

6 JO SUNG DU M 29-Jan-54 Korean M00573188 24-Sep-18 C/E

7 SIN SEONG GIL M 03-Apr-63 Korean M06938443 13-Apr-19 1//E

8 MUHAMMAD ISMAIL MARZUM 13-Apr-82 INDONESIA R680146 26-Mar-13 2/E

9 NARDO HANDONO M 13-Mar-85 INDONESIA V020483 7-May-15 2/EB

10 SISWANTO BIN SUPRAPTO M 28-Mar-84 INDONESIA U018181 12-Oct-14 3/E

11 SUKODO M 19-Jan-65 INDONESIA V749272 20-Jul-15 BSN

12 BAHARUDDIN M 15-Dec-73 INDONESIA U907453 12-Apr-15 ABA

13 EDI HARIANTO M 15-Jan-78 INDONESIA T122256 7-Apr-14 ABB

14 ABDUL JALIL M 02-May-76 INDONESIA U017861 8-Oct-14 ABC

15 FIRMAN M 12-Oct-86 INDONESIA U018933 19-Oct-14 O/S

16 SUJATMAN M 04-Apr-65 INDONESIA A1452031 11-Oct-16 OLR 1

17 BANDAR PARNINGOTAN PAM 17-Apr-71 INDONESIA S886435 29-Jan-14 OLR 2

18 KIRAMAN M 31-Dec-77 INDONESIA S888658 19-Feb-14 OLR 3

19 KARLAN M 21-Jun-58 INDONESIA T800219 25-May-15 C/CK

20 MAIL JAYA M 05-May-75 INDONESIA A0706926 15-Jun-16 M/M

21

I CERTIFY THAT THE ABOVE INFORMATION IS, TO THE BEST OF MY KNOWLEDGE AND BELIEF, TRUE IN EVERY PARTICULAR.

DATE : 23 Dec 2011 _______________________________

*MASTER/OWNER/CHARTERER/AGENT
 IMMIGRATION DEAPRTMENT, HONG KONG
Particulars of Members of the Crew of a Ship Arriving in Hong Kong
VESSEL : M/T Bow Plata OWNER : SUN LEAF SHIPPING LOCAL AGENT: SWIRE SHIPPING
ETA 1600LT 22-JAN 2010 LAST PORT ZHUHAI, CHINA PURPOSE DISCGARGING CARGO
GRT 11615.00T NEXT PORT NINBO , CHINA ETD 26TH JAN 2010

I CERTIFY THAT THERE ARE ON BOARD 22 CREW AND NIL PASSENGER AS DEFINES IN THE IMMIGRATION ORDINANCE, INCLUDING
NIL SUPERNUMERARY, NIL DISTRESS (D.B.S.) AND NIL STOWAWAY.

DATE : 7/9/2024 MASTER GIM YEONG IL

FIRST SIGN ON SEAMAN BK

Surname, Forename & patronymics incl (initial) SEX RATING PLACE & DATE OF BIRTH NATIONALITY
PLACE & DATE NO. ISSUED
1 GIM YEONGIL M MSTR BUSAN 20-Aug-48 Korean Kota Kinabalu #REF! BS114-00900 BUSAN
2 JEONG YEONG SEOK M C/O BUSAN 21-Jan-86 Korean Sapangar Bay 1-Jul-11 BS038-00761 MANILA
3 WIDI HERMAWAN M 2/OA BANGKALAN 13-Jul-80 INDONESIA SINGAPORE 24-Dec-11 W017298 MANILA
4 SAHIRUDIN OKTAVIA M 2/OB JAKARTA 3-Oct-83 INDONESIA SINGAPORE 30-Dec-99 X084299 MANILA
5 RIKO HERDIYANTO M 3/O INDRAMAYU 11-Aug-87 INDONESIA SINGAPORE 30-Dec-99 T051455 MANILA
6 JO SUNG DU M C/E BUSAN 29-Jan-54 Korean SINGAPORE 1-Oct-11 KS791-18145 BUSAN
7 SIN SEONG GIL M 1//E BUSAN 3-Apr-63 Korean Sapangar Bay 11-Oct-11 BS084-04265 MANILA
8 MUHAMMAD ISMAIL MARZUQI M 2/E PATI 13-Apr-82 INDONESIA SINGAPORE 1-Oct-11 X024933 MANILA
9 NARDO HANDONO M 2/EB PEKALONGAN 13-Mar-85 INDONESIA SINGAPORE 14-Jul-11 R067573 MANILA
10 SISWANTO BIN SUPRAPTO M 3/E TEMANGGUNG 28-Mar-84 INDONESIA SINGAPORE 24-Dec-11 R067564 CEBU
11 SUKODO 0 M BSN JAKARTA 19-Jan-65 INDONESIA SINGAPORE 23-Aug-11 V071016 ZAMBOANGA
12 BAHARUDDIN 0 M ABA TAMARA 15-Dec-73 INDONESIA SINGAPORE 14-Jul-11 W004528 MANILA
13 EDI HARIANTO M ABB SURABAYA 15-Jan-78 INDONESIA SINGAPORE 13-Nov-11 W049075 MANILA
14 ABDUL JALIL M ABC BANGKALAN 2-May-76 INDONESIA SINGAPORE 13-Nov-11 X061182 MANILA
15 FIRMAN 0 M O/S BENTENG 12-Oct-86 INDONESIA SINGAPORE 1-Oct-11 Y075036 CEBU
16 SUJATMAN 0 M OLR 1 PURWODADI 4-Apr-65 INDONESIA SINGAPORE 24-Dec-11 X038891 ILOILO
17 BANDAR PARNINGOTAN PARDOSI M OLR 2 PARSOBURAN 17-Apr-71 INDONESIA SINGAPORE 29-May-11 V023263 MANILA
18 KIRAMAN 0 M OLR 3 PALOPO 31-Dec-77 INDONESIA SINGAPORE 23-Aug-11 S058993 MANILA
19 KARLAN 0 M C/CK PURWOKERTO 21-Jun-58 INDONESIA SINGAPORE 29-Jul-11 X044639 MANILA
20 MAIL JAYA M M/M PALOPO 5-May-75 INDONESIA SINGAPORE 18-Jun-11 T051271 BATANGAS
21 0 0 M 0 0 30-Dec-99 0 30-Dec-99 30-Dec-99 12/30/1899 LEGAZPI
22 0 #REF! M 0 0 30-Dec-99 #REF! 30-Dec-99 30-Dec-99 12/30/1899 ILOILO

REMARKS: ALL CREW POSSESS VALID SEAMAN BOOKS AND PASSPORTS.

VACCINATION LIST

VACCINATION LIST
Vessels's Name: PIONEER SPIRIT
Date: 9-Jul-24
PORT:

YELLOW FEVER
No Rank Name COLERA ISSUED DATE
EXPIRY

1 MSTR GIM YEONGIL 02-Apr-12

2 C/O JEONG YEONG SEOK 13-Oct-15
3 2/OA WIDI HERMAWAN 03-Aug-20
4 2/OB SAHIRUDIN OKTAVIA 30-Nov-17
5 3/O RIKO HERDIYANTO 19-Nov-17
6 C/E JO SUNG DU 20-Oct-18
7 1//E SIN SEONG GIL 13-Aug-12
8 2/E MUHAMMAD ISMAIL MARZUQI 21-Apr-18
9 2/EB NARDO HANDONO 27-Aug-18
10 3/E SISWANTO BIN SUPRAPTO 30-Jul-19
11 BSN SUKODO 06-Jan-20
12 ABA BAHARUDDIN 03-Mar-18
13 ABB EDI HARIANTO 13-Dec-17
14 ABC ABDUL JALIL 14-May-17
15 O/S FIRMAN 12-Nov-19
16 OLR 1 SUJATMAN 26-Apr-17
17 OLR 2 BANDAR PARNINGOTAN PARDOSI 06-Oct-13
18 OLR 3 KIRAMAN 14-Feb-17
19 C/CK KARLAN 30-Dec-20
20 M/M MAIL JAYA 19-Jul-19

(REMARK)

MASTER OF M/T PIONEER SPIRIT

U.S. Department of Justice
Immigration and Naturalization Service Passenger List - Crew List
Prior to arrival in the United States, complete a separate form a) working crew; and b) passengers and supernumeraries. In addition to its initial completion, the crew list
shall be updated to reflect crew changes and other relevant activity (or lack thereof) until the vessel departs the United States.

Vessel Name: M/T LAUREL GALAXY Nationality: PANAMA Official Number: IMO 9296884
Last foreign port (Place & Country): TERNEUZEN NETHERLAND Date sailed from foreign: 2/17/2009

Date of Arrival in U.S. Arrival Port: # of Crew (including Master): 22 # of Passengers NIL

Agent at Arrival (Name & Address): ISS SHIPPI

Will crew perform longshore work while vessel is in the United States? [ X ] NO [ ] YES (Provide applicable INA Section 258 Exemption):

PROPOSED ITINERARY
Next U.S. Port(s) Arrival Date Vessel Agent (Name & Address)
Houston 11th Mar 2009 Inchcape Shipping Services Houston
Texascity 12th Mar 2009 Inchcape Shipping Services Galveston
Freeport 13th Mar 2009 Inchcape Shipping Services Galveston
Lake charles 15-Mar-09 Inchcape Shipping Services Lake charles

PASSENGER LIST x CREW LIST - Page 1 of 2

List individuals alphabetically. Crew who join the vessel subsequent to its arrival while in the United States must be added to the original list and the appropriate date
recorded in the 'Date Joined' column. The 'Date Separated' column must be used when a listed crewman is separated from the vessel while it is in the United States.
Any crewman designated as "REFUSED" in the 'Government Use Only' column is to be detained on the vessel at all times.

Date Inspection Status

Position Date
Family First Name Date of Nationality/ Separated (INS Use Only)
or Title Joined
Name & Initial Birth Document # (Crew Checked box indicates
(Crew Only) (Crew Only)
Only) subsequent parole
Filipino
ALCASID ROLAND PORTABES 1-Feb-74 PP0818562 2AE 7-Aug-08
Filipino
ARCAY RAY GALVEZ 19-Feb-74 UU0826679 ABB 3-Sep-08
Filipino
BACOSA 3-Dec-63 QQ0197862 J2/O 7-Aug-08
Filipino
BALLESTEROS GUILBERT SAMUYA 12-Feb-72 SS0944126 C/CK 2-Jun-08
#REF! Filipino
BESWIN AIVAN ARAUJO 30-Jan-81 TT0621955 ABC 29-Sep-08
Filipino
BOTAVARA JOHN WILFRED MORITE 16-Dec-88 XX0742784 DCD1 30-Jan-09
Filipino
CABANLIT SELVINO OBDIN 23-Jun-60 TT0945057 1AE 13-Feb-09
Filipino
CAMPOMAYOR ERIC RAMOS 18-Oct-85 SS0899191 OSB 9-Nov-08
Filipino
CHAVEZ ALFONSO MARAHAY 17-Mar-67 XX2134256 OLR 30-Jan-09
X CONTINUED
I-418 Receipt Number (POE - YYMMDD - Stamp # - Military Time)
RECEIPT FOR CREW (INS Use Only). I-418 Receipt Number at right indicates that the
Immigration and Naturalization Services has received the CREW LIST containing the names of all
members of crew, including Master, on board said vessel at time of its arrival.

INS Port of Arrival (address):

SUMMARY OF DEPARTURE
Vessel Agent (at Departure): Following this vessel's departure from the United States, ensure that crew list reflects all crew additions and separations and is promptly
submitted to the Immigration and Naturalization Service office at the port of departure. Summarize the departure circumstances by providing the following information:

Agent at Departure (Name & Address):

Date of Departure: Port of Departure: Total Added Crew: 23 Total Separated Crew:

Form I-418 (Rev. 03/07/2002)N

 MASTER'S CERTIFICATION

MASTER: Execute the following oath before a Customs Officer as to all arriving passengers on all vessels, and to a Customs Officer and an
Immigration Officer as to all departing crew on United States Flag Vessels, and before an Immigration Officer authorized to administer oaths as to all
departing passengers on vessels.

I certify that Customs baggage declaration requirements have been made known to incoming passengers, that any required Customs baggage
declarations have been or will simultaneously herewith be filed as required by law and regulation with the proper Customs officer; and that the
responsibilities devolving upon this vessel in connection therewith, if any, have been or will be discharged as required by law or regulation before the
proper Customs officer. I further certify that there are no steerage passengers on board this vessel (46 U.S. C. 151-163).

Signature of Master:

CERTIFICATION OF COPY OF CREW LIST OF UNITED STATES FLAG VESSEL

I certify that this is a true copy of the original crew list of the named American vessel, which original crew list is on file in this office. Given under my
hand and seal of office at the customho on .
Signature of Customs Officer:

PASSENGER LIST x CREW LIST - Page 2 of 2 (CONTINUATION)

Vessel Name: M/T LAUREL GALAXY Arrival Port in U.S.: Arrival Dat

Status
Date
Position Date (INS Use Only)
Family First Name Date of Nationality/ Separated
or Title Joined Checked box
Name & Initial Birth Document # (Crew
(Crew Only) (Crew Only) indicates
Only)
subsequent
Filipino
DELOS REYES AGUSTIN VICENTE 23-Aug-76 UU0768122 BSN 2-Jun-08
0
GANADO MARVIN NACAR 10-Feb-82 PP0669979 AB(A) 29-Sep-08
Korean
GIM YEONG IL 20-Aug-48 M78858943 MSTR 14-Feb-09
Filipino
GUMTANG JORHIL NEBRES 5-Dec-65 XX1614618 3AE 3-Sep-08
Filipino
MADEJA SOCRATES II AMABLE 2-Sep-79 VV0105143 O/S(A) 9-Nov-08
Filipino
MAGALIT LEGASPI JR.VILLARUEL 24-Oct-50 XX2156713 CM 9-Nov-08
### Filipino
MAPUTE DESIDERIO JR. PELIGRINO 22-Apr-64 QQ0292612 OLR(A) 29-Sep-08
Filipino
PACLIBAR PATERNO III SITJAR 3-Nov-65 NN0490719 OLR(B) 2-Jun-08
Filipino
RUANO WILFREDO MELLEJOR 4-Nov-56 NN0157941 2/O 27-Jun-08
Filipino
SALES ANTONIO III RECONALLA 27-Mar-87 XX0311340 E/CDT 27-Jun-08
Filipino
SATUMBAGA REYNALDO SASANA 29-Nov-69 QQ0637725 3/O 18-Sep-08
Filipino
SILLO RAMIE SUGIDE 16-Feb-78 UU0530749 M/M 29-Sep-08
Filipino
VAFLOR FRANCISCO DALOG 9-Jun-52 PPO494399 C/E 12-Mar-09
KOREA
YANG SU SEUNG 24-Nov-64 JN4008601 SUPT 5-Mar-09

CONTINUED
I-418 Receipt Number (INS Use

Form I-418 (Rev. 03/07/2002)N

 KT MARINE
CREW EVALUATION REPORT
M/T : BOW PLATA
9-Jul-24

NAME OF VESSEL : M/T Bow Plata 1st Quarter Report

RANK MSTR 2nd Quarter Report
NAME OF CREW : GIM YEONGIL 3rd Quarter Report
DATE OF ONBOARD : 07-Dec-11 4th Quarter Report
PERIOD OF ONBOARD : 12年 7月 3日 Crew Disembarking

ITEMS EVALUTION
A. PERSONAL CONDITION ( 個人性格面)
A-1 : HEALTH ( 建康 ) 1 2 3 4 ⑤ N/A
A-2 : PRUDENCE ( 愼重性 ) 1 2 3 4 5 N/A
A-3 : OBEDIENCE ( 從順性 ) 1 2 3 4 5 N/A
A-4 : SERIOUSNESS ( 鎭面目 ) 1 2 3 4 5 N/A
A-5 : PUNCTUALITY ( 時間嚴守 ) 1 2 3 4 5 N/A
A-6 : COMPATIBILITY ( 强調性 ) 1 2 3 4 5 N/A

B. PROFESSIONAL CAPACITY ( 個人業務面 ) EVALUTION

B - 1 : COMMANDING QUALITY FOR OFFICERS, BOSUN , 1 2 3 4 5 N/A
1/OILER & CHIEF STEWARD (職員.職長 指揮能力)
B - 2 KNOWLEDGE OF HIS RANK ( 自職 知識) 1 2 ③ 4 5 N/A
B - 3 RESPONSIBILITY ( 責任感 ) 1 2 3 4 5 N/A
B - 4 DISCIPLINE ( 敎育訓練度 ) 1 2 3 4 5 N/A
B - 5 DILIGENCE ( 硏究心 ) 1 2 3 4 5 N/A
B - 6 CONDUCT ( 管理能力 ) 1 2 3 4 5 N/A
B - 7 ENGLISH LANGUAGE ( 語學力 ) 1 2 3 4 5 N/A
B - 8 MANNER FOR HIS SUPERIRORS ( 上職者 對態度 ) 1 2 3 4 5 N/A
B - 9 MANNER FOR HIS DUTY ( 職務能度 ) 1 2 3 4 5 N/A
B -10 OFFICE WORK ( 事務職 ) 1 2 3 4 5 N/A
B - 11 WELL VERSED IN SMS ( 安全管理SYSTEM 精通度) 1 2 3 4 5 N/A

EVALUTION : 1. ( EXCELLENT ) 2. ( GOOD ) 3. ( AVERAGE ) 4. ( POOR )

5. ( UNSATISFACTORY ) N/A ( NOT APPLICABLE )

COMMENT OF MASTER , C/ENGINEER

CHIEF ENG' / CHIEF OFF : APPROVED MASTER:

COMMENT OF COMPANY
 SMS

BODY TEMPERATURE

Vessels's Name: BOW PLATA

Date:
25-Apr-10

Place : NINGBO

Inspecter GIM YEONGIL

Application : Routine Unannounced

No Rank Name Vessel's Situation TEMP C

1 MSTR GIM YEONGIL Vessel's Situation TEMP 36.5

2 C/O JEONG YEONG SEOK Vessel's Situation TEMP 36.0

3 2/OA WIDI HERMAWAN Vessel's Situation TEMP 3.0

4 2/OB SAHIRUDIN OKTAVIA Vessel's Situation TEMP 36.0

5 3/O RIKO HERDIYANTO Vessel's Situation TEMP 36.5

6 C/E JO SUNG DU Vessel's Situation TEMP 36.0

7 1//E SIN SEONG GIL Vessel's Situation TEMP 36.0

8 2/E MUHAMMAD ISMAIL MARZUQI Vessel's Situation TEMP 36.5

9 2/EB NARDO HANDONO Vessel's Situation TEMP 36.0

10 MSTR GIM YEONGIL Vessel's Situation TEMP 36.5

11 BSN SUKODO Vessel's Situation TEMP 36.0

12 ABA BAHARUDDIN Vessel's Situation TEMP 36.0

13 ABB EDI HARIANTO Vessel's Situation TEMP 36.5

14 ABC ABDUL JALIL Vessel's Situation TEMP 36.0

15 O/S FIRMAN Vessel's Situation TEMP 36.0

16 OLR 1 SUJATMAN Vessel's Situation TEMP 36.5

17 OLR 2 BANDAR PARNINGOTAN PARDOSI Vessel's Situation TEMP 36.0

18 OLR 3 KIRAMAN Vessel's Situation TEMP 36.5

19 C/CK KARLAN Vessel's Situation TEMP 36.0

20 M/M MAIL JAYA Vessel's Situation TEMP 36.5

21 0 0 Vessel's Situation TEMP 36.0

22 Indonesia 0 Vessel's Situation TEMP 36.0

 X-mas Bonus from Owner
Vessels's Name: PIONEER SPIRIT
Date: 9-Jul-24
PORT: Sriracha, Thailand

No Rank Name Received Signature

1 MSTR GIM YEONGIL $15.00

2 C/O JEONG YEONG SEOK $15.00

3 2/OA WIDI HERMAWAN $15.00

4 2/OB SAHIRUDIN OKTAVIA $15.00

5 3/O RIKO HERDIYANTO $15.00

6 C/E JO SUNG DU $15.00

7 1//E SIN SEONG GIL $15.00

8 2/E MUHAMMAD ISMAIL MARZUQI $15.00

9 2/EB NARDO HANDONO $15.00

10 3/E SISWANTO BIN SUPRAPTO $15.00

11 BSN SUKODO $15.00

12 ABA BAHARUDDIN $15.00

13 ABB EDI HARIANTO $15.00

14 ABC ABDUL JALIL $15.00

15 O/S FIRMAN $15.00

16 OLR 1 SUJATMAN $15.00

17 OLR 2 BANDAR PARNINGOTAN PARDOSI $15.00

18 OLR 3 KIRAMAN $15.00

19 C/CK KARLAN $15.00

20 M/M MAIL JAYA $15.00

TOTAL $300
(REMARK)
MASTER OF M/T PIONEER SPIRIT
 KT MARINE CO., LTD
APPRAISAL-OFFICER
(Confidential Report)

Name : SIN SEONG GIL Vessel : M/T BOW PLATA Rank: 1//E
Period under Review Fm 11-Oct-11 To 9-Jul-24 (For office use) Emplo
APPRAISAL WORK SHEET: Answer as Yes / No for present rank or Higher rank
TASK PERFORMANCE AND ADMINISTRATIVE SKILLS.
The application of knowledge and experience to accomplish the duties and responsibilities of the position with the maximum quality and quantity
Technical knowledge Yes Quick learner Yes Results and decisions on schedule Yes
Technical knowledge Yes Accuracy Yes Cost conscious in use of spares, overtime etc. Yes
Exercise initiative Yes Effective communication up/downwarYes Handover duties effectively Yes
Planning and organising his workload Yes Work with maximum safety Yes Environmental awareness Yes
JUDGEMENT. The ability to analyse problems decisively and accurately, to evaluate data objectively and to form appropriate generalisations?
Assess situations quickly/accurately Yes Sound decisions & give sound advise Yes Consciously try to profit from his mistakes
LEADERSHIP. The ability to win respect and loyalty, to give and take constructive criticism, to help in the development of others and to guide people
in their relationships, for effective teamwork.
Harmonious working relationships Yes Ensuring subordinates are familiar Yes Delegating, planning and organising others’ Yes
Effective monitor & control others Yes Respect and confidence subordinate Yes Commitments to training and developing otheYes
Effective discipline Yes Effective alcohol control in others Yes Yes
PERSONAL QUALITIES. The habits, attitudes, traits and emotional qualities which characteristically affect one's relationship with others
Adaptable in meeting new situations Yes Work tactfully with a minimum of Yes Positive & realistic in career advancement Yes
Co-operative in work situations Yes friction and tension Yes Able to communicate clearly and concisely Yes
Comments on the negative answers:

APPRAISAL SUMMARY (to be completed in all cases)

OVERALL PERFORMANCE ASSESSMENT. Assess the appraisee's overall performance by ticking the box below which most closely
1
summarises your assessment of him.
Category-1 Outstanding or exceptional performance.
✘ Category-2 Performance which is definitely better than normally expected from occupants of this rank.
✘ Category-3 Competent, reliable and consistent job performance which meets the requirements of this rank.
✘ Category-4 Performance which requires certain improvements in one or more basic aspects of the rank
✘ Category-5 Inadequate performance which consistently fails to meet the basic requirements of the rank.
PLANS FOR IMPROVED PERFORMANCE IN PRESENT RANK (This section should be completed in all cases. A copy of the
2
comments and plans for improvement should be given to the appraisee.)
In what aspects of his work would you like to see the appraisee improve?
He has been work hard He is agumetimetive
What plans have you made with the appraiser to bring about these improvements?

3 SUITABILITY FOR PROMOTION (Tick appropriate box) 4 REEMPLOYMENT (Tick appropriate box)
✘ Category-A Ready for promotion ✘ YES If No, please give reasons
✘ Category-B Not yet ready for promotion. Specify in Com ✘ NO
✘ Category-C Promotion not foreseen. Please give reasons
Comments:
He made so many mistake for given job. He attend work late frequently
OTHER COMMENTS : Does the appraisee have any personal problems (e.g. alcohol, drugs, health, personality, home circumstances) which
5
have any adverse effect on his current work performance, or which might potentially affect his work performance in the future?
✘ Yes If yes, please specify
✘ No
6 COMMENTS BY THE CREW ON HIS APPRAISAL (To be completed after interview with appraiser).

Signature of the Crew member appraised

Department Head Master:

Change #1 Date Issued:01 Oct 2006 Page 1 QMS Form 5.1/29

 KT MARINE CO., LTD
CREW AND TRAINEES PERFORMANCE ASSESSMENT
(Confidential Report)

Name : JO SUNG DU Vessel : M/T BOW PLATA Rank: C/E

Period under Review Fm 1-Oct-11 To 9-Jul-24 (For office use) Emplo
APPRAISAL SUMMARY (to be completed in all cases)
OVERALL PERFORMANCE ASSESSMENT. Assess the appraisee's overall performance by ticking the box below which most closely
1
summarises your assessment of him.
Category-1 Outstanding or exceptional performance.
✘ Category-2 Performance which is definitely better than normally expected from occupants of this rank.
✘ Category-3 Competent, reliable and consistent job performance which meets the requirements of this rank.
✘ Category-4 Performance which requires certain improvements in one or more basic aspects of the rank
✘ Category-5 Inadequate performance which consistently fails to meet the basic requirements of the rank.

2 SUITABILITY FOR PROMOTION (Tick appropriate box)

✘ ✘ Suitable for promotion if opportunity arises (meet requirements for next rank, and possesses the personal qualities
Yes No
for this rank). Please state which rank.
✘ ✘
Yes No Is promotion desired by appraisee

Comments:

3 SAFETY: (Tick appropriate box)

Very good ✘ Satisfactory ✘ Not sastisfactory ✘ What is his commitment to working safely ?
Comments:
He has bad manner.
4 ENVIRONMENTAL AWARENESS: (Tick appropriate box)
Yes ✘ No ✘ If No, please give comments
Comments:

5 TRAINING
Please indicate which rank: ] Training book
How many training objectives has the person completed during this assignment?
How many training objectives have this person still to achieve?

6 PLANS FOR IMPROVED PERFORMANCE IN PRESENT RANK This section should be completed in all cases. A copy of the comments
and plans for improvement should be given to the appraisee
In what aspects of his work would you like to see the appraisee improve?

What plans have you made with the appraiser to bring about these improvements?

7 REEMPLOYMENT (Tick appropriate box)

Yes ✘ No ✘ If No, please give reasons

8 OTHER COMMENTS : Does the appraisee have any personal problems (e.g. alcohol, drugs, health, personality, home circumstances) which have
any adverse effect on his current work performance, or which might potentially affect his work performance in the future? (Tick appropriate box.)

✘ ✘ If No, please give reasons

Yes No

9 COMMENTS BY THE CREW ON HIS APPRAISAL (To be completed after interview with appraiser).

Signature of the Crew member appraised

Department Head Master:

Change #1 Date Issued:01 Oct 2006 Page 1 QMS Form 5.1/29