APPLICATION FORM

 Name: Igor  Surname: Kozlov
 Date of birth:  Place of birth: Rubanovka, Kherson reg., Ukraine
 Permanent address: Kherson, Ukraine
 Passport (OVIR): AK 570671   Place of issue: Kherson  Date of issue: 08.10.2004  Valid until: 08.10.2014
 Seaman’s book: AB 418960  Place of issue: Kherson  Date of issue: 01.04.2009  Valid until: 01.04.2014
 Citizenship: Ukraine  Expiry date of U.S. visa: 02.03.2013
 Marital Status  Married
 Next of kin: (name, pas. No)  wife - Kozlova Irina MP 227201
 Supported children under age of 18  
 (name, surname, date of birth)  
 Knowledge of English language  Satisfactory
 Education:  Qualification:  Date of Issue:
 Sevastopol Navy High Engineering School   Marine Engineer  23.06.1992

 Certificates of STCW 78/95

No.

Place

Date of issue

Expiry date

 Certificate of competency  00578/2008/11  Kherson

03.10.2008

---

 Endorsement STCW  00578/2008/11  Kherson

03.10.2008

18.09.2013

 Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1)  04851/2008/25/01  Sevastopol

18.09.2008

18.09.2013

 Carrying Dangerous & Hazardous cargo (B-V/4, B-V/5)  13930 SV  Sevastopol

18.09.2008

18.09.2013

 Advanced Fire Fighting (A-VI/3)  04875/2008/25/04  Sevastopol

18.09.2008

18.09.2013

 Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2)  04863/2008/25/02  Sevastopol

18.09.2008

18.09.2013

 Medical First Aid (A-VI/4-1)  04886/2008/25/05  Sevastopol

18.09.2008

18.09.2013

 Maintenance of Electrical and Electronic Engineering   1160 SV  Sevastopol

18.09.2008

18.09.2013

 Tanker Certificates  

   

 

 

 Chemical Tanker (Advanced and Familiarization, A-V/1 p.2-7)  04899/2008/25/10  Sevastopol

18.09.2008

18.09.2013

 Oil Tanker (Advanced and Familiarization, A-V/1 p.2-7)  04904/2008/25/11  Sevastopol

18.09.2008

18.09.2013

Sea service (during five last years):

Name of vessel

Company

DWT

Flag

Type

Position

From

To

 1. Marmara-Don  Zolotie Vorota   4000  Ukraine  Dry cargo

motorman

27.07.2005

09.10.2005

 2. Marmara-Don  Zolotie Vorota   4000  Ukraine  Dry cargo

3-rd Eng

10.10.2005

20.03.2006

 3. Caribbean Carrier  Seabulk shipping   25000  Greece  Cement cargo

3-rd Eng

09.07.2006

27.05.2007

 4. Uruguay Star   Star Reefers UK Ltd   10629  Liberia  Reefer

3-rd Eng

24.09.2007

11.02.2008

 5. Brasil Star   Star Reefers UK Ltd   10629  Liberia  Reefer

3-rd Eng

31.03.2008

31.08.2008

 6. Uruguay Star   Star Reefers UK Ltd   10629  Liberia  Reefer

2-nd Eng

25.10.2008

08.02.2009

 7. Gonduras Star   Star Reefers UK Ltd   10629  Liberia  Reefer

2-nd Eng

30.04.2009

20.08.2009

 8. Uruguay Star   Star Reefers UK Ltd   10629  Liberia  Reefer

2-nd Eng

31.10.2009

05.02.2010

 9. Gonduras Star   Star Reefers UK Ltd   10629  Liberia  Reefer

2-nd Eng

29.03.2010

06.07.2010

Automation (A1/A2)

Main Eng. Maker/Model

Engine Stroke

Engine Total HP

Aux. Engine Maker/Number

Aux. Engine H.P. / KW

Unmanned

Without El.Eng.

 1. ---

RD/G-60

4

2x900

SKL/2

/100

 

 

 2. ---

RD/G-60

4

2x900

SKL/2

/100

 

 

 3. ---

Fiat/

2

10800

Daihatsu/1, SAKM/2, Deutc/2

/700, 900, 380

 

 

 4. A1

Sulzer 6RTA62

2

15700

Sulzer ATL/3

1000/1350

yes

 

 5. A1

Sulzer 6RTA62

2

15700

Sulzer ATL/3

1000/1350

yes

 

 6. A1

Sulzer 6RTA62

2

15700

Sulzer ATL/3

1000/1350

yes

 

 7. A1

Sulzer 6RTA62

2

15700

Sulzer ATL/3

1000/1350

yes

 

 8. A1

Sulzer 6RTA62

2

15700

Sulzer ATL/3

1000/1350

yes

 

 9. A1

Sulzer 6RTA62

2

15700

Sulzer ATL/3

1000/1350

yes

 

 Experience at sea: Since 1992  Knowledge Personal Computer (Yes / No): yes
 Medical Certificate  ¹ 44.925  Issued: 15.07.2010  Place: Odessa  Exp.date: 15.07.2011
 Vaccination for cholera valid until:  Vaccination for yellow fever valid until: 12.04.2018