FOR NEAR COASTAL VOYAGE

MARINE CREW MATRIX COMPETENCIES DECLARATION FORM

VESSEL NAME LCT ARMANSYA FORTUNA 07
CONTRACT NUMBER 40004420001465A
DATE 17-May-16
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

Proficiency Certificate (STCW' 95) with validity max. 5 years Other Certificate
Years Experience
Certificate of Endorseme
on Seaman Certificate ARPA Lifting &
Name Position Similiar vessel
Competency nt MCU TF OT CT
Book (ANT/ATT) Number BST SCRB MFA MC AFF RADAR (If GMDSS GOC / ORU Rigger's Cert SSO ISM Code BRM / ERM ECDIS CM CMHB
(min 5 years) License (If Tanker) (If Tanker) (If Tanker)
installed)
Class &
Years - Month No & Exp date 10 digit Expired date Expired date Expired date Expired date Expired date Expired date Expired date Expired date Expired date Expired date Expired date Expired date Expired date Expired date Expired date Expired date Expired date Expired date Expired date Expired date Expired date
Issued date
W 059528
Marzuki Ramli Master 30 ANT III 6200 023820 22-12-20 09-12-20 09-11-20 09-11-20 09-11-20 19-10-20 09-11-20 09-11-20 11-12-20 29-10-20 07-05-17 16-10-20 25-03-17 12-11-17

Ismail Chief Officer 23 C 036297 ANT IV 6200 087001 06-07-21 11-02-21 11-01-21 11-01-21 25-07-20 11-01-21 11-11-20 16-11-20 18-06-20 14-12-18 08-05-17 07-08-19

Syariffudin 2nd Officer 9 E 065841 ANT IV 6200 074467 25-03-21 23-12-20 22-10-20 26-10-20 27-10-20 23-10-20 28-01-20 16-02-21 27-11-20 19-12-18 07-05-17 28-10-20

3rd Officer

Romi Patandianan Chief Engineer 4 B 015306 ATT III 6200 542629 23-04-17 22-02-17 02-03-17 08-03-17 16-01-17 16-03-17 08-05-17 28-01-17 29-03-17

Achmad Deni Ladiku 2nd Engineer 1 C 001917 ATT IV 6201 290606 14-3-21 09-12-20 04-04-18 10-04-18 16-11-20 08-04-18 07-05-17 02-11-20 22-04-18 30-04-18

Lahmuddin 3rd Engineer 21 D 058988 ATT V 6200 515177 02-10-17 18-10-17 05-10-20 05-10-17 15-10-17 07-05-17

Bosun

Adi Pujono AB 1 9 C 084348 ANT D 6200 256698 12-09-17

Abdul Kadir AB 2 5 B 062984 R. DECK 6202 0156973 17-04-18

Sade AB 3 18 B 042720 R. DECK 6200 0849513 09-02-20 09-12-21 16-02-18 21-02-18 07-05-17

Basir Oiler 1 4 B 062967 R. ENGINE 6202 0106473 05-06-17 11-11-16

Oiler 2
Oiler 3
Deck Hand
Engine Hand

Rusdi Umar Cook 5 Y 066744 ANT D 6201 312294 07-12-18

Messboy
Deck Cadet

Yandri Limbong Engine Cadet 0.8 D 058966 CADET/E 62115011730 03-05-20 07-05-20 06-05-15 08-05-17

404090
13-04-09 13-04-09 13-04-09 13-04-09 13-04-09 13-04-09 13-04-09 15-2-09 4030904 13-04-09
Doni Triwibawa Prakasa Marine Coordinator B000962 ANT-II 620007714 29-11-10 29-11-10 7020
6200395793N
Ricky Mambrasar Marine Coordinator W048937 ANT III 6200395793N30316 30316 30-09-15 13-02-12 09-06-15 21-05-15 07-07-15 26-06-15 03-06-15 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 Muchtar Harris

President Director Contract Accountable Manager