Capital Ship Management Corp.

HRM: 03-03A-02

SEAFARERS RECORD Applicants Surname: Cernisencu Rank: 3engineer Applicants First Name: Age: 26

APPLICATION FORM Alexandru Cristian tulcea

Date of birth:30.03.1986

Place of birth:

Home address:

blv 1 decembrie 1918 bl. C1 sc.b ap.5 constanta Next of kin: Cernisencu alexandra Telephone: 0755896808

Marit Singl Marrie X al e d Statu s: DOCUMENTS Passport Seamans book National License/Diploma STCW Endorsement/COC Flag Endorsement Medical Fitness Certificate

NUMBER
14685204 22591 CT 31721

ISSUING AUTHORITY

Date Issued
29.06.09 31.07.07 02.07.09

Expiry Date
29.06.14 17.03.13 26.06.14

A&B,ROTTERDAM

TRAINING CERTIFICATES

YES NO

ISSUING AUTHORITY

Date Iss ue d

Expiry Date

LIFE-SAVING & FIRE FIGHTING VI / 1-1, 1-2, 1-3, 14 PERSONAL SURVIVAL TECHNIQUES A-VI/1 PERSONAL SAFETY AND SOCIAL RESPONSIBILITIES A-VI/1 SURVIVAL CRAFT & RESCUE BOATS ADVANCED FIRE FIGHTING MEDICAL FIRST AID MEDICAL CARE RADAR, ARPA, BRIDGE TEAMWORK A-I/12 A-I I/2 WATCHKEEPING GMDSS (GO) PREVENTION OF POLLUTION A-II/1 A-II/2 HANDLING OF DANGEROUS CARGOES A-II/1 A-II/2 MARITIME ENGLISH A-II/1 A-II/2 TANKER FAMILIARIZATION SPECIALIZED CHEMICAL TANKER FAMILIARIZATION ECDIS TRAINING A-II/1 A-II/2 V/1, 1-7 SPECIALIZED TANKER FAMILIARIZATION V/1 8-14 V/1 15-21 II/III IV/2 VI/ 2-1 VI/ 3-1 VI/ 4-1 VI/ 4-2

x x x x x x 24.11.11 24.11.16 30.11.2011 02.12.2011 29.11.2016 01.12.2016

x x x x x

8.12.2011 29.11.2011 22.11.2011

7.12.2016 28.11.2016 21.11.2016 18.02.11

18.02.11

18.02.16

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Capital Ship Management Corp.

HRM: 03-03A-02

SEAFARERS RECORD
SHIP SECURITY OFFICER TRAINING BRIDGE/ENGINE TEAM AND RESOURCE MANAGEMENT SHIP HANDLING AND MANEUVERING SIMULATION A-II/1 A-II/2 ICE NAVIGATION TRAINING TANKER MANAGEMENT AND SELF-ASSESSMENT RISK ASSESSMENT AND INCIDENT INVESTIGATION SAFETY OFFICER TRAINING OTHERS: x

APPLICATION FORM
03.07.09 03.07.14

KNOWLEDGE OF ENGLISH: VETTING EXPERIENCE: USA TRANSIT VISA

VG

20082691790004

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Capital Ship Management Corp. SEAFARERS RECORD PREVIOUS SEA SERVICE - MINIMUM LAST FIVE YEARS COMPANY LOWLAND AB CREW AB CREW STATUS STATUS MARLOW FAIR PLAY VESSEL MARLENE GREEN NYK VEGA NYK LYRA NAFTOCEMENT8 ANDREEAS A AHTS MAGNUS BW BAUHINIA RANK 3E 3E 3E 3E 3E EC EC TYPE CONT CONT CONT CEMC CONT AHTS VLCC FLAG ROTTERD AM PANAMA PANAMA PANAMA PANAMA A&B HONG KONG DWT 11890 97825 75201 3998 5967 1767 301019 ENGINE TYPE VARTSILA MAN B@W MAN B&W MAN DEUTS MAN MAN B&W FROM 07.08.1 2 19.01.1 2 16.04.1 1 04.11.1 0 01.04.1 0 20.07.0 9 4.11.07 TO 19.09.1 2 23.05.1 2 28.09.1 1 23.01.1 1 06.08.1 0 16.09.0 9 31.03.0 8

HRM: 03-03A-02 APPLICATION FORM

REASON FOR SIGNING OFF

Ship sold End of contract

End of contract End of contract End of contract End of contract End of contract

MASTER / OFFICER SUPPLEMENT

RANK TOTAL YEARS IN RANK TOTAL YEARS WITH OPERATOR TOTAL YEARS ON THIS TYPE OF TANKER applicable) TOTAL YEARS ON ALL TYPES OF TANKERS applicable) TOTAL YEARS ON BULK CARRIERS applicable) (as (as (as 0.4 0.4 0.8 3 engineer 1.5 Actual sea service Calendar years Actual sea service Actual sea service Actual sea service DATE: 03.01.2013

APPLICANTS SIGNATURE:

(use 1 decimal i.e., 2.4 yrs)

FOR CAPITAL SHIP MANAGEMENT CORP. CREW DEPT USE ONLY PROPOSED BY MANNING OFFICE/AGENT: DATE REVIEWED & APPROVED FOR INITIAL PROCESSING:

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