APPLICATION FORM
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APPLICATION FORM |
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| Name: Vitaliy | Surname: Aftanov | ||||||
| Date of birth: 23.12.1976 | Place of birth: Odessa reg. | ||||||
| Permanent address: Odessa, Ukraine | |||||||
| Passport (OVIR): AX 111509 | Place of issue: Izmail | Date of issue: 20.09.2002 | Valid until: 20.09.2012 | ||||
| Seaman’s book: AB 431901 | Place of issue: Izmail | Date of issue: 22.09.2009 | Valid until: 22.09.2014 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | mother - Aftanova Mariya | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Kiyv State Marine Academy | Navigator | 26.09.2007 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 01635/2007/07 | Nikolaev |
04.10.2007 |
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| Endorsement STCW | 01635/2007/07 | Nikolaev |
04.10.2007 |
29.07.2012 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 14451 KT | Kyiv |
17.09.2007 |
17.09.2012 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00620/2007/07 | Nikolaev |
03.10.2007 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00620/2007/07 | Nikolaev |
03.10.2007 |
12.09.2012 |
| Radar Observation and Plotting (A-II/1,2) | 6515 KT | Kyiv |
09.08.2007 |
09.08.2012 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 6039 KS | Kyiv |
10.09.2007 |
10.09.2012 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 3984 KS | Kyiv |
26.08.2007 |
26.08.2012 |
| Advanced Fire Fighting (A-VI/3) | 06007 KT | Kyiv |
03.08.2007 |
03.08.2012 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 09369 KT | Kyiv |
22.09.2007 |
22.09.2012 |
| Medical First Aid (A-VI/4-1) | 04550 KT | Kyiv |
29.07.2007 |
29.07.2012 |
| Ship's Medical Care (A-VI/4-2) | 04550 KT | Kyiv |
29.07.2007 |
29.07.2012 |
| Belize Endorsement | 1288/08 | Belize |
07.03.2008 |
29.07.2012 |
| Cambodia Endorsement | 09-01-025632 | Cambodia |
23.01.2009 |
29.07.2012 |
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Tanker Certificates |
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| Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 20845 IZ | Izmail |
25.07.2009 |
24.07.2014 |
| LPG carrier (Advanced and Familiarization, A-V/1, p.2-7) | 20118 IZ | Izmail |
25.07.2009 |
24.07.2014 |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 20843 IZ | Izmail |
25.07.2009 |
24.07.2014 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Rosa Delmas | Sun Ltd |
5100 |
Malta |
Gen cargo |
AB |
12.04.2004 |
26.09.2004 |
| Moon Shine | Silverhill Vent |
4500 |
Antigua |
Bulker |
OS |
05.07.2005 |
10.01.2006 |
| Moon Shine | Silverhill Vent |
4500 |
Antigua |
Bulker |
AB |
11.05.2006 |
16.12.2006 |
| Ulika | ERBS Shipping Co Ltd |
3000 |
Liberia |
Tanker |
AB |
31.01.2007 |
01.08.2007 |
| Roksolana 1 | Med Global Group Ltd |
5151 |
Belize |
Gen cargo |
2-nd Off |
03.11.2007 |
10.06.2008 |
| A.P.Sky | Clan Marine Ltd |
5207 |
Cambodia |
Gen cargo |
2-nd Off |
15.12.2008 |
02.07.2009 |
| Experience at sea: Since 2004 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ 1829 | Issued: 02.10.2008 | Place: Izmail | Exp. date: 02.10.2009 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 17.11.2014 | |||