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CREW REPORT MVAS 2025
CREW REPORT FORM MVAS 2025
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Please enable JavaScript in your browser to complete this form.
Email
*
PHONE NUMBER
*
Full Name
*
First
Last
POSITION
*
STATUS (Mark only one)
*
Single
Married
MVAS CREW ID
*
You can find it on your Contract *
DATE OF BIRTH (Example: January 7, 2019)
*
ADDRESS
*
ADDRESS DIFFERENT THEN KTP
KTP NO
*
PASSPORT NUMBER
*
PASSPORT EXPIRATION DATE (Example: January 7, 2019)
*
C1D VISA EXPIRE
*
SEAMAN BOOK NUMBER
*
DATE SUPERVISOR (Example:
SEAMAN BOOK EXPIRATION DATE (Example: January 7, 2019)
DID YOU EVER LOST A PASSPORT ? Mark only one
*
NO
YES
BASIC SAFETY TRAINING [ BST ] EXPIRE DATE (Example: January 7, 2019)
*
SECURITY AWARENESS TRAINING [ SAT ] EXPIRE DATE (Example: January 7, 2019)
*
CROWD MANAGEMENT EXPIRE DATE (Example: January 7, 2019)
*
CRISIS MANAGEMENT EXPIRE DATE (Example: January 7, 2019)
*
PSCRB - PROFICIENCY AND RESCUE BOAT EXP DATE (Example: January 7, 2019)
*
BNSP - BADAN NATIONAL SERTIFICASI -EXPIRE DATE (Example: January 7, 2019)
MEDICAL EXPIRE DATE (Example: January 7, 2019)
MEDICAL EXPIRE DATE (Example: January 7, 2019) (copy)
1ST EMERGENCY CONTACT PERSON NAME, PHONE & RELATION ( MOTHER , FATHER , WIFE )
*
2ND EMERGENCY CONTACT PERSON NAME, PHONE & RELATION ( MOTHER , FATHER , WIFE )
*
NAME IN SOCIAL MEDIA FACEBOOK
*
NAME IN SOCIAL MEDIA INSTAGRAM
OTHER SOCIAL MEDIA
FATHER NAME
*
FATHER DATE OF BIRTH (Example: January 7, 2019)
*
MOTHER NAME
*
MOTHER DATE OF BIRTH (Example: January 7, 2019)
*
WIFE/HUSBAND NAME - CONTOH Maria Erna
WIFE/HUSBAND/ DATE OF BIRTH
SIGN OFF DATE (Example: January 7, 2019)
*
NAME OF THE SHIP
*
YOUR LAST POSITION ONBOARD
*
SUPERVISOR NAME
*
By submitting this form
*
PDPL
By submitting this form, you acknowledge and agree that your personal data will be processed in accordance with applicable data protection laws. While the European Union's General Data Protection Regulation (GDPR) does not directly apply to data processing within Indonesia, we adhere to principles similar to those outlined in the GDPR to ensure the security and confidentiality of your information. Furthermore, you understand that Indonesia has enacted its own Personal Data Protection Law (PDPL), heavily influenced by the GDPR, which aims to protect the personal data of Indonesian citizens and residents. We are committed to complying with the Indonesian PDPL and ensuring your data is handled responsibly and securely. You consent to the collection, storage, and processing of your personal data for the purposes outlined in our privacy policy.
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