Crew Registration

A. Seafarer Details

Seafarer Code*

Numbers only, 10 digits

Rank / Position*

Certificate of Competency*

Certificate Issue Date*

B. STCW Certificates

Select at least 3 certificates that you hold.

Selected: 0

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B2. Certificate Details

Enter the number and validity dates for each certificate you selected.

C. Personal Information

📎 Document Uploads

Upload CV (PDF, max 1 MB)*

📎 Upload CV (PDF, max 1 MB)

Upload ID Card / KTP (JPG, max 1 MB)*

📎 Upload ID Card / KTP (JPG, max 1 MB)

Upload Tax Card / NPWP (JPG, max 1 MB)*

📎 Upload Tax Card / NPWP (JPG, max 1 MB)

Upload Seaman's Book (PDF, max 1 MB)*

📎 Upload Seaman's Book (PDF, max 1 MB)

Upload Passport (PDF, max 1 MB, optional)

📎 Upload Passport (PDF, max 1 MB, optional)

👤 Personal Data

Fields marked with * are auto-filled from uploaded documents. Please verify and correct if needed.

First Name*

Last Name

Religion*

Gender*

Blood Type*

ID Card No. (NIK)*

Tax ID No. (NPWP)*

ID Card Address*

Email Address*

Mobile Phone No.*

Place of Birth*

Date of Birth*

Current Address*

Nationality*

Marital Status*

Work Experience*

Height (cm)*

Weight (kg)*

Shoe Size*

Family Member Name (emergency)*

Family Phone No.*

Last Education*

Education Certificate Issue Date*

Seaman's Book No.*

Seaman's Book Issue Date*

Passport No. (optional)

Passport Issue Date (optional)

D. Sea Service History

No.	Company Name	Rank / Position	Vessel Type	Sign On Date	Sign Off Date	Action

E. Terms & Declaration

I hereby declare that all statements, data, information and all documents attached in my application for crew selection at PT Perusahaan Pelayaran Gurita Lintas Samudera are true. If it is later found that the data / documents I submitted are incorrect and / or there is forgery, then all decisions that have been made based on those documents are null and void by law and I am willing to be subject to sanctions in accordance with applicable laws and regulations.

I declare that I have read, understood, and agree to the above declaration.

Crew Registration Form

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