APPLICATION FORM
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APPLICATION FORM |
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| Name: Guram | Surname: Katamadze | ||||||
| Date of birth: 26.02.1977 | Place of birth: Batumi | ||||||
| Permanent address: Batumi, Georgia | |||||||
| Passport (OVIR): 07AE43136 | Place of issue: Georgia | Date of issue: 10.08.2007 | Valid until: 10.08.2017 | ||||
| Seaman’s book: AB 015774 | Place of issue: Georgia | Date of issue: 15.08.2007 | Valid until: 15.08.2017 | ||||
| Citizenship: Georgia | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | . | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Very Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Batumi State Marine Academy | Navigator | 0005721 | 2002 | ||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 013703 | Georgia |
30.01.2003 |
30.01.2008 |
| Endorsement STCW | 403707 | Georgia |
07.08.2007 |
22.07.2012 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 403507 | Georgia |
07.08.2007 |
23.07.2012 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 130907 | Georgia |
07.08.2007 |
01.08.2012 |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 130907 | Georgia |
07.08.2007 |
01.08.2012 |
| Radar Observation and Plotting (A-II/1,2) | 403707 | Georgia |
07.08.2007 |
22.07.2012 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 403707 | Georgia |
07.08.2007 |
22.07.2012 |
| ISM Code | 14907 | Georgia |
08.08.2007 |
06.08.2012 |
| Advanced Fire Fighting (A-VI/3) | 403607 | Georgia |
07.08.2007 |
23.07.2012 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 403407 | Georgia |
07.08.2007 |
24.07.2012 |
| Medical First Aid (A-VI/4-1) | 438907 | Georgia |
21.08.2007 |
17.08.2012 |
| Oil Tanker specialized (advanced) | 403407 | Georgia |
07.08.2007 |
24.07.2012 |
| Ship Security Officer (ISPS) A/2.1.6,A/12.1,A/12.2,B/8,B/9,B/13 | 018705 | Georgia |
01.09.2005 |
26.08.2010 |
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Tanker Certificates: |
. |
. |
. |
. |
| Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 403407 | Georgia |
07.08.2007 |
24.07.2012 |
| Crude oil washing | 403407 | Georgia |
07.08.2007 |
24.07.2012 |
| Inert gas system | 403407 | Georgia |
07.08.2007 |
24.07.2012 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Siren | Baizing shipping |
6500 |
Syrian |
Gen. cargo |
2-nd Off |
28.06.2004 |
25.02.2005 |
| Hesnes | Tsakos |
70000 |
Malta |
Tanker |
4-th Off |
08.09.2005 |
14.01.2006 |
| Hesnes | Tsakos |
70000 |
Malta |
Tanker |
3-rd Off |
12.01.2006 |
25.08.2006 |
| Boraq | Hanseatic |
46200 |
Saudia Arabia |
Chem. Tanker |
4-th Off |
07.09.2006 |
14.05.2007 |
| Experience at sea: Since 2004 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: | Place: | Exp. date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: | |||