Aaaaaaa: 1. CONTACT DETAILS (Enter Details)
Aaaaaaa: 1. CONTACT DETAILS (Enter Details)
Aaaaaaa: 1. CONTACT DETAILS (Enter Details)
F-005/01.13.
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Office Use Only
Ref. No.
Attach
Photo
Here
Country of Residence
DEPARTMENT
(Deck/Engineer)
Availability /expected
wages
Title
First Name
Nationality
Surname
Tel No 1
Address
Tel No 2
Height (CM)
E mail
Waist (Inch)
Nearest Airport
Weight (Kg)
Skype ID
(Enter details)
NOK Name
NOK Address
NOK Tel No
NOK Relationship
3. CERTIFICATE OF COMPETENCY (Latest only)
Details
No. Cert.
Issue Date
Expiry Date
Place of Issue
(Enter details)
No. Certificate
Place of Issue
Passport
Seamans Book National
Seamans Book Internat.
USA VISA
VISA
5. STCW CERTIFICATES
Issue Date Expiry Date
Basic training
Advanced Fire Fighting
Medical Care
Medical First Aid
Proficiency in survival
craft and rescue boat
Navigation, Radar &
ARPA Simulator
Tanker Familiarization
ECDIS
No. Certificate
Place of Issue
Magmaris Ltd.
F-005/01.13.
GMDSS
Ship Handling Simulator
BOSIET
ITSO
HUET
DP system
maintenance
Rank
Vessel
Name
Vessel
type
Flag
GRT
DWT
Engine
Type
KW
Signed on
Signed off
Reason for
discharg
I confirm that the details given are to the best of my knowledge accurate and true, that I am in legal possession of the
above qualifications and certificates. I also agree that my personal details can be used by Magmaris ltd for
employment purposes.
Signiture :
Date: