Magmaris Ltd. F-005/01.13.

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Offshore, Crewing, Shipping & Consulting Agency
Ivana Gundulića 41, 22000 Šibenik, Croatia
tel: + 385 22 340 476 ;Fax: + 385 22 340 491;
e-mail:

Please complete this form in black ink or type

1. CONTACT DETAILS (Enter details)
RANK / Country of Residence
DEPARTMENT (Deck/Engineer) / Availability /expected wages
Title / Date and place of Birth
First Name / Nationality
Surname / Tel No 1
Address / Tel No 2
Height (CM) / E mail
Waist (Inch) / Nearest Airport
Weight (Kg) / Skype ID
Shoe size/ Overall size / / / T-Shirt size/ Cargo Pant Size /
2. NEXT OF KIN DETAILS (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
4. CERTIFICATE CHECK LIST (Enter details)
Details / Issue Date / Expiry Date / No. Certificate / Place of Issue
Passport
Seamans Book National
Seamans Book Internat.
USA VISA
VISA
5. STCW CERTIFICATES
Issue Date / Expiry Date / No. Certificate / Place of Issue
Basic training
Advanced Fire Fighting
Medical Care
Medical First Aid
Proficiency in survival craft and rescue boat
Navigation, Radar & ARPA Simulator
Tanker Familiarization
ECDIS
GMDSS
Ship Handling Simulator
BOSIET
ITSO
HUET
DP system maintenance
6. SEA SERVICE (Previous Sea Experience – Earliest Date First)
Company / 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: