APPLICATION FORM
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APPLICATION FORM |
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| Name: Mikhailo | Surname: Malyuga | ||||||
| Date of birth: 05.02.1954 | Place of birth: Zaporozhie reg., Ukraine | ||||||
| Permanent address: Mariupol, Ukraine | |||||||
| Passport (OVIR): AT 043841 | Place of issue: Mariupol | Date of issue: 07.02.2002 | Valid until: 07.02.2012 | ||||
| Seaman’s book: AB 323031 | Place of issue: Mariupol | Date of issue: 06.11.2006 | Valid until: 07.02.2012 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 17.05.2010 | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Irene Malyuga | ||||||
| Supported children under age of 18 | 1. Polina Malyuga, 05.08.1993 | ||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Zhdanovsky Metallorgical Institute | Heat-power Engineering | 1983 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00043/2002/06 | Mariupol |
11.09.2002 |
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| Endorsement STCW | 00043/2002/06 | Mariupol |
24.10.2006 |
03.10.2011 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 13966-AS | Mariupol |
03.10.2006 |
03.10.2011 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 0844/2005 | Mariupol |
17.05.2005 |
17.05.2010 |
| Panama Seaman's book | 310766 | Panama |
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21.03.2012 |
| Cyprus Seaman's book | CY 070143 | Cyprus |
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27.09.2014 |
| Antigua Seaman's book | 49370 | Antigua |
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07.06.2010 |
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Tanker Certificates |
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| Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 02061-AS | Mariupol |
15.12.2006 |
15.12.2011 |
| LPG carrier (Advanced and Familiarization, A-V/1, p.2-7) | 02061-AS | Mariupol |
15.12.2006 |
15.12.2011 |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 02061-AS | Mariupol |
15.12.2006 |
15.12.2011 |
Sea service (during five last years):
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Palmyra | Harren Partner |
7918 |
Antigua |
Multipurp |
Oiler |
23.05.2005 |
10.11.2005 |
| Palawan | Harren Partner |
6650 |
Antigua |
Multipurp |
Oiler-Welder |
10.02.2006 |
05.09.2006 |
| Yu Shan | Eastwind Hellas |
12383 |
Panama |
Reef/Gen cargo |
Fitter-Turner |
15.03.2007 |
01.09.2007 |
| Malaga Carrier | Hanza Marine |
15834 |
Nassau |
Reef/Cont |
Deck Fitter |
04.12.2007 |
02.01.2009 |
| NSM Ambra | Navigator E San Michele |
4180 |
Italy |
Gen cargo |
Fitter-Rep. Eng |
04.04.2009 |
14.10.2009 |
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Experience at sea: Since 1988 |
Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate # 0690 | Issued: 24.12.2009 | Place: Mariupol | Exp.date: 24.12.2010 | |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 16.09.2018 | |||