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APPLICATION FORM |
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| Name: Igor | Surname: Borzykhin | ||||||
| Date of birth: 17.02.1965 | Place of birth: Kazakhstan | ||||||
| Permanent address: Kherson, Ukraine | |||||||
| Passport (OVIR): EA 826493 | Place of issue: Kherson | Date of issue: 28.03.2008 | Valid until: 28.03.2018 | ||||
| Seaman’s book: AB 388239 | Place of issue: Kherson | Date of issue: 26.03.2008 | Valid until: 26.03.2013 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Elena Borzykhyna | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Satisfactory | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Kherson Maritime College | Radiotechnician | . | 08.07.1985 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency |
00184/2008/11 |
Kherson |
18.03.2008 |
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| Endorsement STCW |
00184/2008/11 |
Kherson |
18.03.2008 |
21.02.2013 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) |
12332/08 KH |
Kherson |
22.02.2008 |
22.02.2013 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) |
8535/08 KH |
Kherson |
22.02.2008 |
22.02.2013 |
| N.Antilles Seaman's book |
33134 |
N.Antilles |
08.04.2005 |
08.04.2010 |
| Panama Seaman's book |
403940HV |
Manila |
20.09.2007 |
19.09.2012 |
Sea service (during five last years):
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Name of vessel |
COMPANY |
DWT |
Flag |
Type |
Position |
From |
To |
| Marlin-II |
Mariteam Shipping Ltd |
3834 |
Dominica |
Trawler |
AB |
21.06.2004 |
26.02.2005 |
| Kaf-D |
DM Shipping and Trading |
2000 |
N.Antilles |
Gen cargo |
AB |
02.04.2005 |
10.08.2005 |
| Vera 777 |
Dewlex Invest Ltd |
5100 |
Panama |
Gen cargo |
AB |
13.09.2007 |
22.01.2008 |
| Nadezhda |
Palas Shipping LLC |
3500 |
Comoras |
Gen cargo |
Bosun |
25.04.2008 |
15.08.2008 |
| Experience at sea: Since 1986 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ ÄÃ 499474 | Issued: 28.03.2008 | Place: Kherson | Exp.date: 28.03.2009 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 22.03.2015 | |||
Ready to work from: any time