JOINING CHECKLIST:ACPL/SMS/06/01

Issue 2 1/4/11
Personal and Next of Kin Details.
(Must be completed by all seafarers PRIOR joining )

NAME: AHMAD AFANDI

NATIONALITY: INDONESIAN
DATE OF BIRTH:- Day: 03 Mth: March Yr: 1987

PLACE OF BIRTH: PINRANG

PASSPORT NUMBER:-______________ EXPIRY DATE:-__________ ISSUED

AT:-_________________
SEAMANS BOOK NUMBER:-_____________________ EXPIRY DATE:___________
MARITAL STATUS:- SINGLE ( X )

MARRIED (

HOME ADDRESS: KOMP.KODAMAR, TAMAN SUNTER INDAH,RT9/RW2

NO. 60, JAK-UT, INDONESIA
TEL (Home): 021-29574593 TEL (Mobile): +62 81295951087
Email: capt.afandi27@gmail.com
NEXT OF KIN
RELATIONSHIP: BROTHER
NAME: ALI SAID
ADDRESS: STREET GAHARU NO.12,RAWABADAK,JAK-UT , INDONESIA

TEL:
DEPENDANTS:- SON / DAUGHTER; PLEASE SPECIFY.
NAME
RELATIONSHIP

DATE OF BIRTH
DAY

Signed: ________________________
Name: AHMAD AFANDI

MTH

Date joining: _________________

(To be filled by HR Dept)

YEAR