APPLICATION FORM

 Name: Petro  Surname: Shramko
 Date of birth: 20.09.1975  Place of birth: Kiev
 Permanent address: Kiev, Ukraine
 Passport (OVIR): KC 530750  Place of issue: Kiev  Date of issue: 29.04.1999  Valid until: 29.04.2009
 Seaman’s book: AB 323419  Place of issue: Mariupol  Date of issue: 12.12.2006  Valid until: 12.12.2011
 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  Good
 Education:  Qualification:  No Diploma:  Date of Issue:
 Kiev State Academy of Water Transport  Navigator  ---  06.07.2001

Certificates of STCW 78/95

No.

Place

Date of issue

Expiry date

 Certificate of competency  00165/2002/07  Nikolaev

06.08.2002

---

 Endorsement STCW  00165/2002/07  Nikolaev

20.08.2002

02.07.2007

 G.M.D.S.S. General Operator (A-IV/2) Certificate  00166/2002/07  Nikolaev

06.08.2002

---

 G.M.D.S.S. General Operator (A-IV/2) Endorsement  00166/2002/07  Nikolaev

06.08.2002

02.08.2007

 Radar Observation and Plotting (A-II/1,2)  R 0037/02  Kiev

02.08.2002

02.08.2007

 Automatic Radar Plotting Aids (ARPA) (A-II/1,2)  A 0060/02  Kiev

07.08.2002

07.08.2002

 Advanced Fire Fighting (A-VI/3)  F 0065/02  Kiev

24.07.2002

24.07.2007

 Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2)  S 0083/02  Kiev

13.07.2002

13.07.2007

 Medical First Aid (A-VI/4-1)  MA 0034/02  Kiev

12.07.2002

12.07.2007

Sea Service (during five last years):

Name of vessel

Company

DWT

Flag

Type

Position

From

To

 Ivan Akulov  Ukrtechflot

3000

Ukraine

Dry Cargo

3-rd Off.

25.12.2003

15.07.2004

 Danapris 4  CSC

3000

Ukraine

Dry Cargo

2-nd Off.

03.03.2006

30.06.2006

 Experience at sea:  Since 2001  Knowledge Personal Computer: Yes
 Medical Certificate:  #  Issued:  Place:  Exp. date:
 Vaccination for cholera valid until:  Vaccination for yellow fever valid until: 20.10.2013