1. RANK
2. DATE FORWARDED TO MMS
3. SEAMAN'S PERSONAL INFORMATION
3.1 Surname*
3.2 First name*
3.3 Nationality
3.4
3.5
3.6
3.7 Email*
3.8
4. SEAMAN'S DOCUMENTS
4.1 Travel passport
.Nationality
Issue Date
Expire Date
4.2 Civil Passport
.Nationality
.
.
4.3 Seaman's Book No
.Nationality
.
.
4.4 Other Seaman’s
Book
.
.
4.5 Other Seaman’s
Book
.
.
4.6 Other Seaman’s
Book
.
.
4.7 Other Seaman’s
Book
.
.
4.8 Valid Shengen Visa ...From
Till
4.9 Valid USA Visa ...From
Till
5. SEAMAN'S LICENCES
5.1 Certificate
of Competency
.Nationality
Issue Date
Expire Date
5.2 Endorsment
.
.Nationality
.
(if avail.)
5.3 Tankers Endor
-sment(Oil&Chem)
.Nationality
.
.
5.4 Tankers Endor
-sment (Oil)
.Nationality
.
.
5.5 Tankers Endor
-sment(Chemical)
.Nationality
.
.
5.6 Another COC
.
.Nationality
.
.
5.7 Another Endor
-sment
.Nationality
.
.
5.8 GMDSS Gene
-ral Operator
.Nationality
.
.
5.9 GMDSS Endor
-sment
.Nationality
.
.
6. SEAMAN'S CERTIFICATES
6.1 Basic Safety
Training
Issue Date
Expire Date (if avail.)
6.2 Proficiency in
Survival Craft
.
.
6.3 Advanced Fire
Fighting
.
.
6.4 Medical First Aid
.Nationality
.
.
6.5 Medical Care
.Nationality
.
.
6.6 Ship Security Officer
.Nationality
.
.
6.7 Ship Safety Officer
.Nationality
.
.
6.8 ROP
.Nationality
.
.
6.9 ARPA
.Nationality
.
.
6.10 Dangerous Cargo
.Nationality
.
.
6.11 Designated
Security Duties
.
.
6.12 Basic Training
For Oil &
Chemical Tankers
.
6.13 Bridge Team
/Resource Management.
.
.
6.14 ECDIS
.Nationality
.
.
6.15 LICOS
.Nationality
.
.
6.16 ICE NAVIGATION
.Nationality
.
.
6.17 RISK ASSESSMENT
.Nationality
.
.
6.18 INCIDENT
INVESTIGATION
.
.
6.19 Vaccination
.Nationality
.
.
6.20 Medical Fitness
.Nationality
.
.
6.21 Drug and Alcohol
Test
.
.
7. PREVIOUS SEA SERVICE
7.1 Vessel’s Name
& Year Built. Flags
RANK
.
Vessel
Engine Type(BHP)
.
S/On Date
S/Off Date
S/Off Reason
7.2 Vessel’s Name
& Year Built. Flags
RANK
.
Vessel
Engine Type (BHP)
.
S/On Date
S/Off Date
S/Off Reason
7.3 Vessel’s Name
& Year Built. Flags
RANK
.
Vessel
Engine Type (BHP)
.
S/On Date
S/Off Date
S/Off Reason
7.4 Vessel’s Name
& Year Built. Flags
RANK
.
Vessel
Engine Type (BHP)
.
S/On Date
S/Off Date
S/Off Reason
7.5 Vessel’s Name
& Year Built. Flags
RANK
.
Vessel
Engine Type (BHP)
.
S/On Date
S/Off Date
S/Off Reason
7.6 Vessel’s Name
& Year Built. Flags
RANK
.
Vessel
Engine Type (BHP)
.
S/On Date
S/Off Date
S/Off Reason
8. SEAMAN’S EDUCATION
9. NEXT OF KIN
9.1
9.2 Relation
9.3
9.4
10. ADDITIONAL INFORMATION
10.1
10.2
10.3
10.4
10.5
10.6
10.7
10.8 Colour of eyes
10.9 Colour of hair
10.10
10.11
11.1 Загрузить свою фотографию (photo-file <2Mb)