APPLICATION FORM

 Name: Oleksiy  Surname: Kosy
 Date of birth: 20.10.1978  Place of birth: Odessa
 Permanent address: Odessa, Ukraine
 Passport (OVIR): AT 286003  Place of issue: Odessa  Date of issue: 26.02.2002  Valid until: 26.02.2012
 Seaman’s book: AB 146112  Place of issue: Odessa  Date of issue: 03.01.2002  Valid until: 25.05.2011
 Citizenship: Ukraine  Expiry date ofU.S. visa: 01.02.2014
 Marital Status  Single
 Next of kin: (name, pas. No)  Mother Kosy Olga
 Supported children under age of 18  .
 (name, surname, date of birth)  .
 Knowledge of English language  Good
 Education:  Qualification:  No Diploma:  Date of Issue:
 Odessa Maritime Training Center  Able Seamen  27024  23.11.2001

Certificates of STCW 78/95

No.

Place

Date of issue

Expiry date

 Certificate of competency

00628/2007/03

Ilichivsk

22.03.2007

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 Endorsement STCW

00628/2007/03

Ilichisk

22.03.2007

05.05.2011

 Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1)

0806/2006

Odessa

05.05.2006

05.05.2011

 Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2)

42021/2005

Odessa

06.05.2005

06.05.2011

 Passenger ships other than Ro-Ro (A-V/3) 

1556

Odessa

03.2008

03.2013

Sea service (during five last years):

Name of vessel

COMPANY

DWT

Flag

Type

Position

From

To

 Krymskay

 Cherazmorput

1000

Ukr

Scow

AB

30.07.2003

13.05.2004

 Stella Quarta

 Lemissoler - Ukraine

13661

Panama

Bulk

OS

10.11.2005

12.04.2006

 Dream

 Tumco navigation Co

22945

Bahamas

Pass

OS

15.08.2006

07.03.2007

 Aristides N.P. 

 Prospero Maritime

68952

MI

Bulk

AB

06.2007

01.2008

 Cape Kestrel 

 Zodiac Maritime Agencies Ltd

160000

UK

Bulk

AB

06.2008

09.2008

 Broadgate 

 Zodiac Maritime Agencies Ltd

34600

Liberia

Bulk

AB

02.2009

08.2009

 Experience at sea: Since 2004  Knowledge Personal Computer (Yes / No): Yes
 Medical Certificate  ¹ 610  Issued: 11.2008  Place: Odessa  Exp.date: 11.2009
 Vaccination for cholera valid until:  Vaccination for yellow fever valid until: 04.04.2012