SEAFARER APPLICATION FORM Personal Information Rank * Date of birth * Surname * Place of birth * First name * Citizenship * Father’s name * Passport # Gender MALE FEMALE Eyes color * Black Brown Blue Green Grey Height * cm Overall size * Weight * kg Shoe size * Hair color * Black Brown Red White Marital status * Married Single Divorced Widower Photo * Delete Loading... Contact Information Address * City * Country * Email * Home telephone Mobile telephone * Mobile telephone 2 Relatives Full name Relation Date of birth Actual address Email Mobile telephone Is next of kin Mother Father Brother Sister Wife Husband Son Daughter Grandmother Grandfather Aunt Uncle other Mother Father Brother Sister Wife Husband Son Daughter Grandmother Grandfather Aunt Uncle other Mother Father Brother Sister Wife Husband Son Daughter Grandmother Grandfather Aunt Uncle other Mother Father Brother Sister Wife Husband Son Daughter Grandmother Grandfather Aunt Uncle other Mother Father Brother Sister Wife Husband Son Daughter Grandmother Grandfather Aunt Uncle other Sea service At least 1 contract Vessel name Flag Type Engine Crewing company Rank Sign on Built DWT Power Sign off Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Austrian Empire Azerbaijan Baden* Bahrain Bangladesh Barbados Bavaria* Belarus Belgium Belize Benin (Dahomey) Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Brunswick and Lüneburg Bulgaria Burkina Faso (Upper Volta) Burma Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Central American Federation* Chad Chile China Colombia Comoros Cook Islands Costa Rica Cote d’Ivoire (Ivory Coast) Croatia Cuba Cyprus Czechia Czechoslovakia Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Germany (German Democratic Republic) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Federal Government of Germany (1848-49)* Fiji Finland France Gabon Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Hanover* Hanseatic Republics* Hawaii* Hesse* Holy See Hong Kong Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kingdom of Serbia/Yugoslavia* Kiribati Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Lew Chew (Loochoo)* Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mecklenburg-Schwerin* Mecklenburg-Strelitz* Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Namibia Nassau* Nauru Nepal New Zealand Nicaragua Niger Nigeria North German Confederation* North German Union* Norway Oldenburg* Oman Orange Free State* Pakistan Palau Panama Papal States* Papua New Guinea Paraguay Peru Philippines Piedmont-Sardinia* Poland Portugal Qatar Republic of Genoa* Republic of Korea (South Korea) Republic of the Congo Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Schaumburg-Lippe* Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Syria Tajikistan Tanzania Texas* Thailand The Bahamas The Cayman Islands The Congo Free State The Duchy of Parma* The Gambia The Grand Duchy of Tuscany* The Netherlands The Solomon Islands The United Arab Emirates The United Kingdom Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Two Sicilies* Uganda Ukraine Union of Soviet Socialist Republics* Uruguay Uzbekistan Vanuatu Venezuela Vietnam Württemberg* Yemen Zambia Zimbabwe Bulk Carrier Container Oil Tanker Ch. Tanker LPG LNG Ro-Ro Lo-Ro Heavy Lift Tug Reefer Passenger Fish Supply Ferry Dry Cargo Dredger PSV Multi-Purpose General Cargo Ro-Flow Research Bunker barge Sailing Universal Pilot boat Hopper Float. Crane Oil Platform AHT OGT Hotel Fireboat Car Carrier AHTS Salvage Diving boat DSV Seismic War ship Submarine Jackup Barge Yacht Floating rig OBO Cable-laying Barge ROV Coaster Drilling research FPSO VLCC AHTS / ROV OSV MSV Trawler Floating Fish Factory Product Tanker Cable/Pipe Layer ABB Electric Motors Alasaka B&W Barreras BOLNES British Polar BRONS-MAN Catepillar Cummins Daihatsu Deuts EMD Fiat GMT GTS Hanshin Hedemora Hitachi Hyundai Hyundai HIMSEN Kawasaki Kobe Mak MAN MAN-B&W Mercedes Mierleess Mitsubishi Mitsui Mohab MWM NIAGATA Niigata NOHAB Normo NVD Pielstick RD Rolls-Royce Bergen Russian diesel SKL Skoda Steam turbine STEWARD & STEVENSON Stork Sulzer Sulzer RTA Turbine Vichman Volvo WARTSILA Wasa Werkspoor Wichmann Wuxi Yanmar Unknown Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Austrian Empire Azerbaijan Baden* Bahrain Bangladesh Barbados Bavaria* Belarus Belgium Belize Benin (Dahomey) Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Brunswick and Lüneburg Bulgaria Burkina Faso (Upper Volta) Burma Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Central American Federation* Chad Chile China Colombia Comoros Cook Islands Costa Rica Cote d’Ivoire (Ivory Coast) Croatia Cuba Cyprus Czechia Czechoslovakia Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Germany (German Democratic Republic) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Federal Government of Germany (1848-49)* Fiji Finland France Gabon Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Hanover* Hanseatic Republics* Hawaii* Hesse* Holy See Hong Kong Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kingdom of Serbia/Yugoslavia* Kiribati Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Lew Chew (Loochoo)* Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mecklenburg-Schwerin* Mecklenburg-Strelitz* Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Namibia Nassau* Nauru Nepal New Zealand Nicaragua Niger Nigeria North German Confederation* North German Union* Norway Oldenburg* Oman Orange Free State* Pakistan Palau Panama Papal States* Papua New Guinea Paraguay Peru Philippines Piedmont-Sardinia* Poland Portugal Qatar Republic of Genoa* Republic of Korea (South Korea) Republic of the Congo Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Schaumburg-Lippe* Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Syria Tajikistan Tanzania Texas* Thailand The Bahamas The Cayman Islands The Congo Free State The Duchy of Parma* The Gambia The Grand Duchy of Tuscany* The Netherlands The Solomon Islands The United Arab Emirates The United Kingdom Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Two Sicilies* Uganda Ukraine Union of Soviet Socialist Republics* Uruguay Uzbekistan Vanuatu Venezuela Vietnam Württemberg* Yemen Zambia Zimbabwe Bulk Carrier Container Oil Tanker Ch. Tanker LPG LNG Ro-Ro Lo-Ro Heavy Lift Tug Reefer Passenger Fish Supply Ferry Dry Cargo Dredger PSV Multi-Purpose General Cargo Ro-Flow Research Bunker barge Sailing Universal Pilot boat Hopper Float. Crane Oil Platform AHT OGT Hotel Fireboat Car Carrier AHTS Salvage Diving boat DSV Seismic War ship Submarine Jackup Barge Yacht Floating rig OBO Cable-laying Barge ROV Coaster Drilling research FPSO VLCC AHTS / ROV OSV MSV Trawler Floating Fish Factory Product Tanker Cable/Pipe Layer ABB Electric Motors Alasaka B&W Barreras BOLNES British Polar BRONS-MAN Catepillar Cummins Daihatsu Deuts EMD Fiat GMT GTS Hanshin Hedemora Hitachi Hyundai Hyundai HIMSEN Kawasaki Kobe Mak MAN MAN-B&W Mercedes Mierleess Mitsubishi Mitsui Mohab MWM NIAGATA Niigata NOHAB Normo NVD Pielstick RD Rolls-Royce Bergen Russian diesel SKL Skoda Steam turbine STEWARD & STEVENSON Stork Sulzer Sulzer RTA Turbine Vichman Volvo WARTSILA Wasa Werkspoor Wichmann Wuxi Yanmar Unknown Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Austrian Empire Azerbaijan Baden* Bahrain Bangladesh Barbados Bavaria* Belarus Belgium Belize Benin (Dahomey) Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Brunswick and Lüneburg Bulgaria Burkina Faso (Upper Volta) Burma Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Central American Federation* Chad Chile China Colombia Comoros Cook Islands Costa Rica Cote d’Ivoire (Ivory Coast) Croatia Cuba Cyprus Czechia Czechoslovakia Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Germany (German Democratic Republic) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Federal Government of Germany (1848-49)* Fiji Finland France Gabon Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Hanover* Hanseatic Republics* Hawaii* Hesse* Holy See Hong Kong Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kingdom of Serbia/Yugoslavia* Kiribati Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Lew Chew (Loochoo)* Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mecklenburg-Schwerin* Mecklenburg-Strelitz* Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Namibia Nassau* Nauru Nepal New Zealand Nicaragua Niger Nigeria North German Confederation* North German Union* Norway Oldenburg* Oman Orange Free State* Pakistan Palau Panama Papal States* Papua New Guinea Paraguay Peru Philippines Piedmont-Sardinia* Poland Portugal Qatar Republic of Genoa* Republic of Korea (South Korea) Republic of the Congo Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Schaumburg-Lippe* Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Syria Tajikistan Tanzania Texas* Thailand The Bahamas The Cayman Islands The Congo Free State The Duchy of Parma* The Gambia The Grand Duchy of Tuscany* The Netherlands The Solomon Islands The United Arab Emirates The United Kingdom Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Two Sicilies* Uganda Ukraine Union of Soviet Socialist Republics* Uruguay Uzbekistan Vanuatu Venezuela Vietnam Württemberg* Yemen Zambia Zimbabwe Bulk Carrier Container Oil Tanker Ch. Tanker LPG LNG Ro-Ro Lo-Ro Heavy Lift Tug Reefer Passenger Fish Supply Ferry Dry Cargo Dredger PSV Multi-Purpose General Cargo Ro-Flow Research Bunker barge Sailing Universal Pilot boat Hopper Float. Crane Oil Platform AHT OGT Hotel Fireboat Car Carrier AHTS Salvage Diving boat DSV Seismic War ship Submarine Jackup Barge Yacht Floating rig OBO Cable-laying Barge ROV Coaster Drilling research FPSO VLCC AHTS / ROV OSV MSV Trawler Floating Fish Factory Product Tanker Cable/Pipe Layer ABB Electric Motors Alasaka B&W Barreras BOLNES British Polar BRONS-MAN Catepillar Cummins Daihatsu Deuts EMD Fiat GMT GTS Hanshin Hedemora Hitachi Hyundai Hyundai HIMSEN Kawasaki Kobe Mak MAN MAN-B&W Mercedes Mierleess Mitsubishi Mitsui Mohab MWM NIAGATA Niigata NOHAB Normo NVD Pielstick RD Rolls-Royce Bergen Russian diesel SKL Skoda Steam turbine STEWARD & STEVENSON Stork Sulzer Sulzer RTA Turbine Vichman Volvo WARTSILA Wasa Werkspoor Wichmann Wuxi Yanmar Unknown Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Austrian Empire Azerbaijan Baden* Bahrain Bangladesh Barbados Bavaria* Belarus Belgium Belize Benin (Dahomey) Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Brunswick and Lüneburg Bulgaria Burkina Faso (Upper Volta) Burma Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Central American Federation* Chad Chile China Colombia Comoros Cook Islands Costa Rica Cote d’Ivoire (Ivory Coast) Croatia Cuba Cyprus Czechia Czechoslovakia Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Germany (German Democratic Republic) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Federal Government of Germany (1848-49)* Fiji Finland France Gabon Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Hanover* Hanseatic Republics* Hawaii* Hesse* Holy See Hong Kong Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kingdom of Serbia/Yugoslavia* Kiribati Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Lew Chew (Loochoo)* Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mecklenburg-Schwerin* Mecklenburg-Strelitz* Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Namibia Nassau* Nauru Nepal New Zealand Nicaragua Niger Nigeria North German Confederation* North German Union* Norway Oldenburg* Oman Orange Free State* Pakistan Palau Panama Papal States* Papua New Guinea Paraguay Peru Philippines Piedmont-Sardinia* Poland Portugal Qatar Republic of Genoa* Republic of Korea (South Korea) Republic of the Congo Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Schaumburg-Lippe* Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Syria Tajikistan Tanzania Texas* Thailand The Bahamas The Cayman Islands The Congo Free State The Duchy of Parma* The Gambia The Grand Duchy of Tuscany* The Netherlands The Solomon Islands The United Arab Emirates The United Kingdom Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Two Sicilies* Uganda Ukraine Union of Soviet Socialist Republics* Uruguay Uzbekistan Vanuatu Venezuela Vietnam Württemberg* Yemen Zambia Zimbabwe Bulk Carrier Container Oil Tanker Ch. Tanker LPG LNG Ro-Ro Lo-Ro Heavy Lift Tug Reefer Passenger Fish Supply Ferry Dry Cargo Dredger PSV Multi-Purpose General Cargo Ro-Flow Research Bunker barge Sailing Universal Pilot boat Hopper Float. Crane Oil Platform AHT OGT Hotel Fireboat Car Carrier AHTS Salvage Diving boat DSV Seismic War ship Submarine Jackup Barge Yacht Floating rig OBO Cable-laying Barge ROV Coaster Drilling research FPSO VLCC AHTS / ROV OSV MSV Trawler Floating Fish Factory Product Tanker Cable/Pipe Layer ABB Electric Motors Alasaka B&W Barreras BOLNES British Polar BRONS-MAN Catepillar Cummins Daihatsu Deuts EMD Fiat GMT GTS Hanshin Hedemora Hitachi Hyundai Hyundai HIMSEN Kawasaki Kobe Mak MAN MAN-B&W Mercedes Mierleess Mitsubishi Mitsui Mohab MWM NIAGATA Niigata NOHAB Normo NVD Pielstick RD Rolls-Royce Bergen Russian diesel SKL Skoda Steam turbine STEWARD & STEVENSON Stork Sulzer Sulzer RTA Turbine Vichman Volvo WARTSILA Wasa Werkspoor Wichmann Wuxi Yanmar Unknown Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Austrian Empire Azerbaijan Baden* Bahrain Bangladesh Barbados Bavaria* Belarus Belgium Belize Benin (Dahomey) Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Brunswick and Lüneburg Bulgaria Burkina Faso (Upper Volta) Burma Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Central American Federation* Chad Chile China Colombia Comoros Cook Islands Costa Rica Cote d’Ivoire (Ivory Coast) Croatia Cuba Cyprus Czechia Czechoslovakia Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Germany (German Democratic Republic) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Federal Government of Germany (1848-49)* Fiji Finland France Gabon Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Hanover* Hanseatic Republics* Hawaii* Hesse* Holy See Hong Kong Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kingdom of Serbia/Yugoslavia* Kiribati Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Lew Chew (Loochoo)* Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mecklenburg-Schwerin* Mecklenburg-Strelitz* Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Namibia Nassau* Nauru Nepal New Zealand Nicaragua Niger Nigeria North German Confederation* North German Union* Norway Oldenburg* Oman Orange Free State* Pakistan Palau Panama Papal States* Papua New Guinea Paraguay Peru Philippines Piedmont-Sardinia* Poland Portugal Qatar Republic of Genoa* Republic of Korea (South Korea) Republic of the Congo Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Schaumburg-Lippe* Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Syria Tajikistan Tanzania Texas* Thailand The Bahamas The Cayman Islands The Congo Free State The Duchy of Parma* The Gambia The Grand Duchy of Tuscany* The Netherlands The Solomon Islands The United Arab Emirates The United Kingdom Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Two Sicilies* Uganda Ukraine Union of Soviet Socialist Republics* Uruguay Uzbekistan Vanuatu Venezuela Vietnam Württemberg* Yemen Zambia Zimbabwe Bulk Carrier Container Oil Tanker Ch. Tanker LPG LNG Ro-Ro Lo-Ro Heavy Lift Tug Reefer Passenger Fish Supply Ferry Dry Cargo Dredger PSV Multi-Purpose General Cargo Ro-Flow Research Bunker barge Sailing Universal Pilot boat Hopper Float. Crane Oil Platform AHT OGT Hotel Fireboat Car Carrier AHTS Salvage Diving boat DSV Seismic War ship Submarine Jackup Barge Yacht Floating rig OBO Cable-laying Barge ROV Coaster Drilling research FPSO VLCC AHTS / ROV OSV MSV Trawler Floating Fish Factory Product Tanker Cable/Pipe Layer ABB Electric Motors Alasaka B&W Barreras BOLNES British Polar BRONS-MAN Catepillar Cummins Daihatsu Deuts EMD Fiat GMT GTS Hanshin Hedemora Hitachi Hyundai Hyundai HIMSEN Kawasaki Kobe Mak MAN MAN-B&W Mercedes Mierleess Mitsubishi Mitsui Mohab MWM NIAGATA Niigata NOHAB Normo NVD Pielstick RD Rolls-Royce Bergen Russian diesel SKL Skoda Steam turbine STEWARD & STEVENSON Stork Sulzer Sulzer RTA Turbine Vichman Volvo WARTSILA Wasa Werkspoor Wichmann Wuxi Yanmar Unknown Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Austrian Empire Azerbaijan Baden* Bahrain Bangladesh Barbados Bavaria* Belarus Belgium Belize Benin (Dahomey) Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Brunswick and Lüneburg Bulgaria Burkina Faso (Upper Volta) Burma Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Central American Federation* Chad Chile China Colombia Comoros Cook Islands Costa Rica Cote d’Ivoire (Ivory Coast) Croatia Cuba Cyprus Czechia Czechoslovakia Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Germany (German Democratic Republic) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Federal Government of Germany (1848-49)* Fiji Finland France Gabon Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Hanover* Hanseatic Republics* Hawaii* Hesse* Holy See Hong Kong Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kingdom of Serbia/Yugoslavia* Kiribati Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Lew Chew (Loochoo)* Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mecklenburg-Schwerin* Mecklenburg-Strelitz* Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Namibia Nassau* Nauru Nepal New Zealand Nicaragua Niger Nigeria North German Confederation* North German Union* Norway Oldenburg* Oman Orange Free State* Pakistan Palau Panama Papal States* Papua New Guinea Paraguay Peru Philippines Piedmont-Sardinia* Poland Portugal Qatar Republic of Genoa* Republic of Korea (South Korea) Republic of the Congo Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Schaumburg-Lippe* Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Syria Tajikistan Tanzania Texas* Thailand The Bahamas The Cayman Islands The Congo Free State The Duchy of Parma* The Gambia The Grand Duchy of Tuscany* The Netherlands The Solomon Islands The United Arab Emirates The United Kingdom Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Two Sicilies* Uganda Ukraine Union of Soviet Socialist Republics* Uruguay Uzbekistan Vanuatu Venezuela Vietnam Württemberg* Yemen Zambia Zimbabwe Bulk Carrier Container Oil Tanker Ch. Tanker LPG LNG Ro-Ro Lo-Ro Heavy Lift Tug Reefer Passenger Fish Supply Ferry Dry Cargo Dredger PSV Multi-Purpose General Cargo Ro-Flow Research Bunker barge Sailing Universal Pilot boat Hopper Float. Crane Oil Platform AHT OGT Hotel Fireboat Car Carrier AHTS Salvage Diving boat DSV Seismic War ship Submarine Jackup Barge Yacht Floating rig OBO Cable-laying Barge ROV Coaster Drilling research FPSO VLCC AHTS / ROV OSV MSV Trawler Floating Fish Factory Product Tanker Cable/Pipe Layer ABB Electric Motors Alasaka B&W Barreras BOLNES British Polar BRONS-MAN Catepillar Cummins Daihatsu Deuts EMD Fiat GMT GTS Hanshin Hedemora Hitachi Hyundai Hyundai HIMSEN Kawasaki Kobe Mak MAN MAN-B&W Mercedes Mierleess Mitsubishi Mitsui Mohab MWM NIAGATA Niigata NOHAB Normo NVD Pielstick RD Rolls-Royce Bergen Russian diesel SKL Skoda Steam turbine STEWARD & STEVENSON Stork Sulzer Sulzer RTA Turbine Vichman Volvo WARTSILA Wasa Werkspoor Wichmann Wuxi Yanmar Unknown Education At least 1 information Institution Faculty Speciality Start Graduate Work experience Organisation Name of job Reason of dissmissal Start Graduate Certificates Documents title Number Issue date Expiry date Travel Passport * Seaman's Book * Certificate of Competency * Certificate of Competency (II) Basic STCW (A-VI/1) * GMDSS Proficiency in Survival Crafts Fast Rescue Boats Advanced Fire Fighting Course Medical First Aid RADAR/ARPA Hazardous materials Security Officer Safety Officer Risk assessment ECDIS Yellow Fever Vaccine Security awareness training Designated Security Duties Foreign languages Information Language Level Certificate I, undersigned, confirm all above information to be true and correct to my best knowledge 02.03.2021 Date