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APPLICATION FORM

 Name: Vasil  Surname: Kulatov
 Date of birth: 01.01.1962  Place of birth: Odessa. Ukraine
 Permanent address: Odessa, Ukraine
 Passport (OVIR): AT 675145  Place of issue: Odessa  Date of issue: 01.02.2001  Valid until: 01.02.2011
 Seaman’s book: AB 072819  Place of issue: Illichevsk  Date of issue: 27.12.2000  Valid until: 27.12.2005
 Citizenship: Ukraine  Expiry date of U.S. visa: NO
 Marital Status  Single
 Next of kin: (name, pas. No)  Mother - Kulatova Vera
 Supported children under age of 18  --
 (name, surname, date of birth)  --
 Knowledge of English language  Poor
 Education:  Qualification:  No Diploma:  Date of Issue:
 Odessa Marine School  Motorman  417  06.1984

Certificates of STCW 78/95

No.

Place

Date of issue

Expiry date

 Certificate of competency

039 IL

Illichevsk

19.09.2003

19.09.2008

 Endorsement STCW

-

-

-

-

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

LZ 03709B

Odessa

20.06.2003

20.06.2008

 Advanced Fire Fighting (A-VI/3)

LZ 50205B

Odessa

20.06.2003

20.06.2008

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

LZ 36993B

Odessa

20.06.2003

20.06.2008

 Crowd Management (A-VI/4-1)

LZ 04166B

Odessa

20.06.2003

20.06.2008

Sea service (during five last years):

Name of vessel

COMPANY

HP/DWT

Flag

Type

Position

From

To

 1. Taras Shevchenko

 Antarctica

21000/21000

Ukraine

passenger

motorman

1984

2004

 Experience at sea: since 1984  Knowledge Personal Computer (Yes / No): No
 Medical Certificate  ¹  Issued:  Place:  Exp.date:
 Vaccination for cholera valid until:

 .

Ready to work from:  ANY TIME

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