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APPLICATION FORM

 Name: Igor  Surname: Akymov
 Date of birth: 01.12.1981  Place of birth: Moldova
 Permanent address: Krasnoye, Slobodzeysky reg, Moldova
 Passport (OVIR): KC 075651  Place of issue: Moldova  Date of issue: 23.10.2002  Valid until: 23.10.2012
 Seaman’s book: AB 341568  Place of issue: Moldova  Date of issue: 01.09.2006  Valid until: 01.09.2011
 Citizenship: Ukraine  Expiry date of U.S. visa: no
 Marital Status  Single
 Next of kin: (name, pas. No)  .
 Supported children under age of 18  .
 (name, surname, date of birth)  .
 Knowledge of English language  Satisfactory
 Education:  Qualification:  No Diploma:  Date of Issue:
 Odessa Maritime Training Centre   Ship's Cook  .  2006

Certificates of STCW 78/95

No.

Place

Date of issue

Expiry date

 Certificate of competency

00426/2006/08

Odessa

30.05.2006

---

 Endorsement STCW

00426/2006/08

Odessa

30.05.2006

18.04.2011

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

0685/2006

Odessa

18.04.2006

18.04.2011

Sea service (during five last years):

Name of vessel

COMPANY

DWT

Flag

Type

Position

From

To

 Experience at sea: -  Knowledge Personal Computer (Yes / No): Yes
 Medical Certificate  ¹  Issued: 14.12.2007  Place: Odessa  Exp.date: 14.12.2008
 Vaccination for cholera valid until:  Vaccination for yellow fever valid until:

Ready to work from:  any time

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