Beruflich Dokumente
Kultur Dokumente
LIMITED
MUMBAI REGION
REGIONAL SECUIRITY HQRS
1ST Floor, Vasudhara Bhavan, Bandra (E),Mumbai 400 051.
Tele Fax No : 022 2699692
1. Name in full
(In block letters)
MIDDLE
SURNAME
WELLMAN
PHOTOGRAPH
2. Father`s Name
: SYAHRIL SAHAR
: 19-06-1979
4. Place of Birth
: DURI
5. Nationality
: INDONESIAN
6. Blood Group
: O+
7. Designation
: QC INSPECTOR
8. Qualification
9. Contractor`s Name
Details
Present Address
Permanent Address
a)
b)
Block CD 19/4
c)
Street Name
HIRANANDANI GARDENS
d)
POWAI
Cikarang Barat
e)
Police Station
POWAI
Cikarang Barat
f)
City
MUMBAI
Cikarang
g)
District
MUMBAI
BEKASI
h)
State
MAHARASHTRA
Indonesia
i)
Pin Code
400 0076
j)
Tel. No.
k)
E-Mail ID
+6282172300419
Syarli.wellman@swiber.com
Syarli.wellman@swiber.com
: Have beard
: A 7337278
: REPUBLIC OF INDONESIA
: 22 JAN 2019
___________________________
Countersigned by the contractor
(Office seal with Name & Designation)
_________________________________
Signature of contract workmen
20. DECLARATION: Attached supporting documents have been scrutinized. He has undergone the
mandatory offshore safety trainings. Certified for issue of NED Passes. The photocopies of all
documents are attested by company representative and they were compared with original by me.
After comparison, the original certificates are returned and attested copies are enclosed herewith
along with Moha Clearance copy.
Date: ___________________
Specimen Signatures: