APPLICATION FORM

 Name: Sergiy  Surname: Dyatkov
 Date of birth: 08.05.1979  Place of birth: Ukraine
 Permanent address: Melitopol, Ukraine
 Passport (OVIR): PO 725549  Place of issue: Melitopol  Date of issue: 10.04.2007  Valid until: 10.04.2017
 Seaman’s book: AB 356820  Place of issue: Nikolaev  Date of issue: 14.06.2007  Valid until: 14.06.2012
 Citizenship: Ukraine  Expiry date of U.S. visa: NO
 Marital Status  Married
 Next of kin: (name, pas. No)  wife - Natalia Dyatkova
 Supported children under age of 18  1. Elizaveta Dyatkova, 04.07.2002
 (name, surname, date of birth)  
 Knowledge of English language  Satisfactory
 Education:  Qualification:  Date of Issue:
 Building Centre   Welder  05.1997

 Certificates of STCW 78/95

 No.

 Place

 Date of issue

 Expiry date

 Certificate of competency  00154/2007/06  Mariupol

30.07.2007

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 Endorsement STCW  00154/2007/06  Mariupol

30.07.2007

10.07.2012

 Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1)  09474-AS  Mariupol

10.07.2007

10.07.2012

 Advanced Fire Fighting (A-VI/3)  09474-AS  Mariupol

10.07.2007

10.07.2012

 Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2)  09474-AS  Mariupol

10.07.2007

10.07.2012

 Medical First Aid (A-VI/4-1)  09474-AS  Mariupol

10.07.2007

10.07.2012

 Ro-Ro Passenger ships (A-V/2)  00154/2007/06  Mariupol

30.07.2007

10.07.2012

 Passenger ships other than Ro-Ro (A-V/3)  00154/2007/06  Mariupol

30.07.2007

10.07.2012

Sea service (during five last years):

Name of vessel

Company

DWT

Flag

Type

Position

From

To

 Victor Talalikhin   CFD  5000

Ukraine

Ro-Ro

motorman

08.2007

02.2008

 Boris Babochkin   CFD  16000

Ukraine

Gen cargo

motorman-fitter

03.2008

08.2008

 Sumy   CFD  22900

Ukraine

Bulk carrier

fitter

01.2009

06.2009

 Shakhtar   CFD  16000

Ukraine

Gen cargo

fitter

10.2009

03.2010

 Experience at sea: Since 2007

 Knowledge Personal Computer (Yes / No): Yes 
 Medical Certificate # 508   Issued: 13.08.2007  Place: Mariupol  Exp.date:
 Vaccination for cholera valid until: 2017   Vaccination for yellow fever valid until: 2017