1. Jl. Kelapa Dua Gang Kelabat, No. 34
North of Jakarta-14120
Telephone No.: +62 214407010
Mobile No.: +62 813 17444976
Email: victortambelangi@yahoo.com
SEAFARER’S APPLICATION FORM
RANK: Master
PERSONAL DETAILS:
Surname:
Tambelangi
Name:
Victor
Availability date:
Any time
Date of Birth:
18.08.1951
Place of Birth:
Sangir
Other names: Nationality:
Indonesia
Address:
Jl. Kelabat dua gang kelabat, No. 34,
North of Jakarta-14120
Tel.No:
+62 21 4407010
Mobile:
+62 813 17444976
Nearest Airport::
Soekarno hatta cinkareng
E-mail:
victortambelangi@yahoo.com
Civil Status:
Married
Next of Kin/ Relationship:
Wife/ Julian Mangisela
Address:
Same as above
Tel.No / Mobile:
Same as above
TRAVEL DOCUMENTS:
Country Number Issue date Expiry date Place
Passport: B0354608 16.01.2015 16.01.2020 Jakarta
National Seaman’s Book: C 073713 18.06.2014 18.06.2017 Tg. Priok
LICENSES:
License Grade of License Number Issue date Expiry date Place
Cert. of
Competency:
COC Class 1 6200040432N10214 17.12.2014 Unlimited Jakarta
Endorsement: COC Class 1 6200040432NA0214 22.12.2014 22.12.2019 Jakarta
Cert. of
Competency:
COC Class 2 6200040432N20104 09.11.2007 Unlimited Jakarta
MEDICAL DOCUMENTS:
Number Issue date Expiry date Place
Health Certificate: 010/MCUIS/AMI/IX/14 23.09.2014 22.09.2016 Jakarta
Drug & Alcohol Test: 010/MCUIS/AMI/IX/14 23.09.2014 22.09.2016 Jakarta
2. Jl. Kelapa Dua Gang Kelabat, No. 34
North of Jakarta-14120
Telephone No.: +62 214407010
Mobile No.: +62 813 17444976
Email: victortambelangi@yahoo.com
COURSES & CERTIFICATES
Course name Level Issue date Number
Basic Safety Training 27.02.2012 6200040432010112
Fire Fighting BASIC / ADV √ 27.02.2012 6200040432060112
Medical
ELEMENTARY First Aid /
MEDICAL FIRST AID √
MEDICAL. CARE √
01.06.2012
27.02.2012
6200040432070212
6200040432080112
Survival Craft & Rescue Boats 27.02.2012 6200040432040112
ARPA 27.02.2012 6200040432020112
RADAR 27.02.2012 6200040432030112
ORU-GOC 06.11.2015 G048016
GMDSS 16.05.2012 6200040432211112
ECDIS 28.05.2012 6200040432281112
Ship Security Officer 12.10.2015 6200040432241115
Bridge Resource/ Team Mgmt. 04.06.2012 6200040432231112
Cert. Of Attendance ISM Code
Internal Auditor
07.09.2001 S1023645-A-04
International Safety
Management Code
28.05.2012 ISMC 1205 1430
BOSIET (Basic Offshore Safety
Induction Emergency Training)
07.09.2013 137157070709130009
Rigging & Slinging 15.05.2013 NU/HSE/2013/05/10600
ISF Malins English Language 82% 13.10.2015 5806C8E4DC77A834
DP Basic Cert. 08.05.2009
DP Advance Cert. 29.04.2010 S199/10
DP Indemnity letter Temporary 3 month 05.11.2015 Validate in progress
DP Assessment Cert. 20.04.2013
MARLINS Test:
TOTAL % LISTENING % GRAMMAR % VOCABULARY % Issue date
82 84 70 87 13.10.2015
TIME AND NUMBERS % PRONUNCIATION % READING % Place of Issue
100 78 83 Jakarta, PT.AAPL Indonesia Crew
3. Jl. Kelapa Dua Gang Kelabat, No. 34
North of Jakarta-14120
Telephone No.: +62 214407010
Mobile No.: +62 813 17444976
Email: victortambelangi@yahoo.com
SEA SERVICE:
Company Rank Date
signed on
Date
signed off
Type HP GRT Name of vessel
Labroy Master Non DP 30.12.1986 01.08.1991 AHT 3600 815 Ocean Neptune
Osa Marine Ch. Mate Non DP 20.10.1992 16.04.1993 AHTS 6000 1650 Odin Osa
Kaiji Singapore Master Non DP 14.08.1993 20.01.1996 AHTS 4800 1200 Kaiji 3
Maritime Master Non DP 24.05.1996 25.04.1997 AHTS 6500 1750 Australia Eagle
Gulf Marine Far East Master Non DP 29.10.1997 05.08.1998 AHTS 5200 1650 Sea Whitch
Gulf Marine Far East Master Non DP 22.12.1998 24.03.1999 AHTS 5200 1650 Sea Whip
Gulf Marine Far East Master Non DP 24.03.1999 11.12.1999 AHTS 5500 1650 Sea Eagle
Gulf Marine Far East Master Non DP 05.02.2000 24.02.2001 AHTS 5500 1650 Sea Diligent
Gulf Marine Far East Master Non DP 01.03.2001 12.12.2002 AHTS 5500 1650 Sea Diligent
Gulf Marine Far East Master Non DP 15.01.2003 15.01.2004 AHTS 5500 1650 Sea Searcher
Gulf Marine Master Non DP 10.11.2004 16.03.2006 PSV 6500 2008 Highland Patriot
Maritime 2002 Master Non DP 19.09.2006 05.05.2007 AHT 5500 1499 Maritime Putri
Zamil Master Non DP 05.04.2008 04.07.2008 AHTS 5200 1161 Zamil 5
Thome Offshore Master Non DP 22.07.2008 04.10.2008 AHTS 15000 2590 Sea Wolf I
Strato Master Non DP 14.10.2008 28.01.2009 AHT 5200 975 Crest Hercules
Strato Master Non DP 01.02.2009 25.04.2009 AHTS 5200 1503 Mahananda
RK Offshore Master/DP1 19.05.2009 06.09.2009 AHTS 5500 1470 Didi-K
RK Offshore Master/DP1 30.09.2009 12.01.2010 AHTS 5500 1494 Capt. John K. (ASD)
RK Offshore Master/ DP2 22.01.2010 05.04.2010 AHTS 10800 2310 Ark Charly
RK Offshore Master/ DP2 12.05.2010 07.08.2010 AHTS 10800 2310 Ark Tze
RK Offshore Master/ DP2 01.09.2010 26.10.2010 AHTS 10800 2310 Ark Charly
RK Offshore Master/ DP2 11.11.2010 09.02.2011 AHTS 10800 2310 Ark Cath
Walvis Master/ DP2 18.03.2011 04.07.2011 AHT 6200 1163 Jascom 21 (ASD)
Walvis Master/ DP2 04.11.2011 12.02.2012 AHT 6200 1163 Jascon-21 (ASD)
Walvis Master/ DP2 14.03.2012 11.05.2012 AHT 6200 1163 Jascon-21 (ASD)
4. Walvis Master/DP2 11.06.2012 01.08.2012 AHT 6200 1163 Jascon-21 (ASD)
Walvis Master/ DP2 01.08.2012 06.11.2012 AHT 6200 1163 Jascon-21 (ASD)
Topaz Master/ DP1 06.01.2013 11.03.2013 AHTS 5500 1678 Topaz Jebel Ali
Topaz Master/ DP1 17.04.2013 12.08.2013 AHTS 5500 1678 Topaz Jaddap
Wintermar Master/ DP2 28.09.2013 20.11.2013 PSV 6500 3245 WM. Makassar (PSV)
GO Offshore Master/ DP2 17.12.2013 20.02.2014 AHTS 8000 2446 GO Rigel
GO Offshore Master/ DP2 17.04.2014 02.09.2014 AHTS 8000 2446 GO Rigel
GO Offshore Master/ DP2 14.10.2014 08.01.2015 AHTS 8000 2446 GO Rigel
GO.Offshore Master/DP2 27.03.2015 06.06.2015 AHTS 8000 2446 Go Rigel
CONTRACTUAL
I hereby affirm that all the information provided by me is true and correct to the best of my knowledge and belief. I further affirm that no Certificate of Competency or License issued to me has ever been revoked or suspended and that they will remain valid during my
anticipated employment plus three months. I consent to “The JS Hamilton Management Co Ltd Sp.zoo Oddział w Polsce” contacting any previous employer of mine for a reference. I allow my personal data shown in the above application to be submitted to one or more
potential employers for the purpose of my recruitment as discussed and in accordance with the Polish Personal Data Protection Act dated 29/08/1997
SIGNATURE________________________________
DATE and PLACE: November 10th.2015
RIG MOVE AND ANCHOR HANDLING
Vessel Name Rig Move Accommodation Barge Anchor Handling Month/ Years Location Lead Boat
AHT. Ocean Neptune Barge : Seram. Dredging Jan. 1987 – August 1990 Anchor handling Total Indonesia Balikpapan Yes
AHTS. Odin Osa Barge Mc.Dermot DL3000. Pipe Line October 1992 – April 1993 Anchor handling pipe line Bongkot Field. Thai Yes
AHTS. Sea Witch Pride California December 1997 Rig Move at Petronas Carigali Kemaman NO
AHTS. Sea Diligent Barge : Teknik Berkat Ferbruary 2000 Anchor handling for positioning at platform Yes
AHTS. Sea Diligent Ensco 52 July 2000 Towing Rig, Singapore – Thailand Yes
AHTS. Sea Diligent Ensco 51 May 2002 Rig Move at location ESSO Malaysia No
AHTS. Sea Searcher
Harvey word & Roger
mowel
March 2003 –November 2003 Rig Move for Positioning at Petronas Malaysia Yes
AHTS Sea Eagle Hyundai May 1999 – November 1999 ROV. Seismic. Touchdown. fish scan at Taiwan Yes
AHTS. Didi K. DP1 Pride August 2008 Towing/ Rig Move. Gabon – Congo Yes
AHTS. Ark Charly. DP2 Semi Sub Scarbeo 3 Ferbruary 2010 Towing/ Rig Move. Congo – Nigeria Yes
ASD.AHT.Jascon 21 DP2 Pride Southern July 2012 Towing/ Rig Move. Gabon – Lagos Port No
AHTS.Topaz Jadaf.DP1 Noble Denton August 2013 Towing / Rig Move. DPC (Dubai) NO
AHTS. Topaz J. Ali. DP1 Noble Denton February 2013 Towing / Rig Move. DPC (Dubai) Yes
AHTS. Go Rigel. DP2 Harkuryu 11 Dec 2013 – May 2015 Towing/ Rig Move. Primer Oil Natuna Yes
AHT. Crest Hercules Hyundai 1000 Oct 2008 – Jan 2009 Towing / Anchor handling gravity anchor. UAE Yes
AHT. Maritime Putri Java Commander Nov 2006 – March 2007 Towing / Anchor handling running pipe. Bombay.High Yes
AHTS. Kaiji III Kaiji V Sept 1993 Towing vessel Kaiji V, Shiogama (Japan)-Singapore Yes
AHT.Ocean Neptune Plat top Barge Oct 1990 – May 1992 Towing Plat top Barge, Singapore-Darwin-Kiunga-Singapore Yes
