Check Lists and Forms File

Issue Date

July - 2014

Revision Date

Issue Status

01

Revision Status

July 2015
01

IMO Crew List

Arrival
2. Port of arrival/departure

CASPIAN 1

1. Name of ship

Departure
3. Date of arrival/departure

NEKA PORT
4. Nationality of ship

5. Port arrived from

IRANIAN

NEKA PORT

------6.Nature and no of identity

document.
(Seaman passport)

7. No

8. Family name, given names

9.Rank or rating

10. Nationality

11. Date and place of birth

Nariman pourmand

MASTER

IRANIAN

GORGAN/1981/12/09

0404821

Ali asghar nemati

Ch/off

IRANIAN

TEHRAN 1981/08/23

0373504

Moein ghahreman

2ND OFF

IRANIAN

ANZALI 1988/09/22

0404717

Ali toufani

Ch eng

IRANIAN

ASTANE 19/04/1975

0424400

Sepehr mahjoubi

2ND ENG

IRANIAN

AMOL 1979/03/21

0319296

ENG

IRANIAN

ANZALI 1965/07/06

0418147

RD

Saeid sayyad chapari

Reza goudarznia

4TH ENG

IRANIAN

BEHSHAHR 1985/02/17

0397586

ETO

BABOLSAR 1961/06/29

0424766

BOSUN

IRANIAN
IRANIAN

ANZALI 1973/01/11

0376684

10

Kazem golbahari
Bahman pourmohammad
najib
Adel nasaf zadeh

AB

IRANIAN

ABADAN 1959/06/25

0287280

11

Mohammad mostofi

OS

IRANIAN

BEHSHAHR 1988/12/09

0414022

12

Oveys kolbadinezhad

OS

IRANIAN

BEHSHAHR 1990/03/03

0404826

13

Hadi darzi

OILER

IRANIAN

BEHSHAHR 1984/06/22

0371206

14
15

Kioumars raji
Reza sedaghati

MOTORMAN IRANIAN
WIPER
IRANIAN

TEHRAN 1984/05/31
BEHSHAHR 1988/09/19

0376722
0424900

16

Shahram rahimi

COOK

IRANIAN

TEHRAN 1979/10/27

0373750

17

Behzad mirzaei

STWARD

IRANIAN

GHAZVIN 1979/07/01

0371012

18

Moein salehnezhad

STWARD

IRANIAN

RASHT 1995/01/07

0399669

19

Mohammad Farazmand

Class Surveyur

IRANIAN

20

Esmaeil Akrami

KEPCO

IRANIAN

21

Korosh Rastgoo

NDCO

IRANIAN

22

Mahmood Julaei

NDCO

IRANIAN

23
24

Mr. Ali Sepehri

Mr. Ebrahim Karimi

W/SHOP
W/SHOP

IRANIAN
IRANIAN

12.Date and signature by Master,authorized agent or officer

23.05.2016

KEPCO

OPN/01/ICL

PAGE 1 OF 1