Crew Matrix Af7 1e4t6m

FOR NEAR COASTAL VOYAGE

VESSEL NAME

LCT ARMANSYA FORTUNA 07

CONTRACT NUMBER

40004420001465A 17-May-16

DATE

MARINE CREW MATRIX COMPETENCIES DECLARATION FORM

I, as the Contract Manager / Representative of PT.SAMUDERA ENERGI TANGGUH For Service Contract No. 40004420001465A hereby declare that personnel listed below have been assessed and confirms where meet with the Company's Standard and/Or STCW '95 of competency, safety behavior and health to work at BP Tangguh. All listed personnel have been explained in regards to scope of work, execution plan, risk assessment, operating procedure, tools/equipment in use and the emergency procedure. I am fully responsible for the validity of information given hereby and will ensure the compliance of this declaration.

BP Marine AsPac ADDITIONAL REQUIREMENTS TO CMID / OVID

Name

Position

Years Experience on Similiar vessel (min 5 years)

Seaman Book

Certificate of Competency (ANT/ATT)

Certificate Number

Endorseme nt License

Years - Month

No & Exp date

Class & Issued date

10 digit

ANT III ANT IV ANT IV

Proficiency Certificate (STCW' 95) with validity max. 5 years

Other Certificate MCU

Lifting & Rigger's Cert

SSO

ISM Code

TF (If Tanker)

OT BRM / ERM (If Tanker)

Expired date

Expired date

Expired date

Expired date

Expired date

Expired date

Expired date

29-10-15 14-12-13 19-12-13

07-05-17 08-05-17 07-05-17

16-10-15 07-08-14 28-10-15

25-03-02

BST

SCRB

MFA

MC

AFF

RADAR

ARPA (If installed)

GMDSS

GOC / ORU

Expired date

Expired date

Expired date

Expired date

Expired date

Expired date

Expired date

Expired date

Expired date

6200 023820 6200 087001 6200 074467

22-12-15 06-07-11 25-03-16

09-12-15 11-02-16 23-12-15

09-11-15 11-01-16 22-10-15

09-11-15 11-01-16 26-10-15

09-11-15 25-07-10 27-10-15

19-10-15 11-01-16 23-10-15

09-11-15 11-11-10 28-01-15

09-11-15 16-11-10 16-02-16

11-12-15 18-06-10 27-11-15

Marzuki Ramli Ismail Syariffudin

Master Chief Officer 2nd Officer 3rd Officer

30 23 9

W 059528 C 036297 E 065841

Romi Patandianan

Chief Engineer

4

B 015306

ATT III

6200 542629

23-04-12

22-02-12

02-03-12

08-03-12

16-01-12

16-03-12

08-05-17

28-01-12

29-03-12

Achmad Deni Ladiku

2nd Engineer

1

C 001917

ATT IV

6201 290606

14-3-16

09-12-15

04-04-13

10-04-13

16-11-15

08-04-13

07-05-17

02-11-15

22-04-13

Lahmuddin

3rd Engineer

21

D 058988

ATT V

6200 515177

02-10-12

18-10-12

05-10-15

05-10-12

15-10-12

07-05-17

16-02-13

21-02-13

07-05-17

Expired date

ECDIS

CT (If Tanker)

CM

CMHB

Expired date

Expired date

Expired date

Expired date

12-11-12

30-04-13

Bosun Adi Pujono

AB 1

9

C 084348

ANT D

6200 256698

12-09-07

Abdul Kadir

AB 2

5

B 062984

R. DECK

6202 0156973

17-04-13

Sade

AB 3

18

B 042720

R. DECK

6200 0849513

09-02-15

09-12-16

Basir

4

B 062967

R. ENGINE

6202 0106473

05-06-12

11-11-11

5

Y 066744

ANT D

6201 312294

07-12-13

Yandri Limbong

Oiler 1 Oiler 2 Oiler 3 Deck Hand Engine Hand Cook Messboy Deck Cadet Engine Cadet

D 058966

CADET/E

62115011730

Doni Triwibawa Prakasa

Marine Coordinator

Rusdi Umar

Ricky Mambrasar

Marine Coordinator

0.8

B000962 W048937

ANT-II ANT III

620007714

03-05-15 13-04-09

6200395793N 6200395793N30316 30316

13-04-09

30-09-15

07-05-15 13-04-09

13-02-12

13-04-09

09-06-15

06-05-15 13-04-09

13-04-09

21-05-15

08-05-17

29-11-10 29-11-10 07-07-15

26-06-15

13-04-09

15-2-09

4030904 03-06-15

404090 7020

13-04-09

18-04-16

During the project OR operation's execution, the listed personnel will comply with the following requirements to ensure all activities can be safely completed. 1. Adherence to the whole process of Permit To Work (PTW), Operating Procedures, HSE requirments, Good Safety behavior practices and accept all consuequences of procedure / regulation violation. 2. Stop the job and immediately to report to Master or Supervisor for any further risk assessment for any unsafe conditions or inconsistencies with the plan as outlined in the PTW (i.e. changing the plan or scope of work or sequence, tools / equipment break down, uncertain or in doubt on executing the job, presence of new hazards). 3. Aware of the hazard, write them down on Level 1 or L2RA and implement the mitigation during work planning, preparation, execution, usage of equipment include other chemical and other hazardous materials (refer to MSDS) if any.

Declared by,

Endorsed by,

Mahmud Tarmizi Amir President Director

Muchtar Harris Contract able Manager