Personal Data

Surname*

Name*

Phone*

Date of birth

Place of birth

Marital status

Number of childs

Adress (100 chars left)

Parent's name

Passport

Place of issue

Date of issue

Number

Validity

USA Visa Number

USA Visa Expiry Date

Seaman Book

Number

Place of issue

Date of issue

Validity

Medical

Medical Visit Number

Medical Visit date

I.L.O. medical examination - number

I.L.O. medical examination - date

Yellow fever expiry date

Licence

Name (Rank)

Number

Licence issued date

Licence validity

STCW

Endorsement

Validity

Malta

Endorsement

Validity

IMO COURSES

Personal survival techniques

ID Date

Medical care / Medical / Elementary first aid

ID Date

Advanced / Basic fire fighting

ID Date

Personal safety and social responsabilities on board ships

ID Date

Prevention of pollution of the marine enviroment - MARPOL 75/78

ID Date

Handling and transport of dangerous, hazardous and harmful cargoes

ID Date

Maritime english

ID Date

Proficiency in survival crefts other than fast boats

ID Date

ARPA, bridge teamwork and search and rescue-management level

ID Date

Radar navigation, radar plotting and use of ARPA operational level

ID Date

G.M.D.S.S. / GOC

ID Date

SECURITY AWARNESS TRAINING

untitled element Date

Tanker familiarisation endorsement

ID Date

Endorsement No. Endorsement Expiry Date

Specialized training for oil tankers endorsement

ID Date

Endorsement No. Endorsement Expiry Date

Specialized training for chemical tankers endorsement

ID Date

Endorsement No. Endorsement Expiry Date

Ship handling and maneuvering simulation

ID Date

B.T. and resource management, engine team management

ID Date

Ship security officer endorsement

ID Date

Endorsement No. Endorsement Expiry Date

Ships safety officer

ID Date

Electronic charts display and information system

ID Date

Risk assessment

ID Date

T.M.S.A.

ID Date

Ships cook specialization

ID Date

Hygiene course for catering personnel

ID Date

VESSELS RECORDS

1

Type Name DWT Sign on

Sign off

Rank Owner Engine

2

Type Name DWT Sign on

Sign off

Rank Owner Engine

3

Type Name DWT Sign on

Sign off

Rank Owner Engine

4

Type Name DWT Sign on

Sign off

untitled element Rank Owner Engine

5

Type Name DWT Sign on

Sign off

Rank Owner Engine

Remarks (200 chars left)

SafetyShoes

Overall

Availability

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