Revision no.

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Shipcare Services Srl
CONSTANTA – ROMANIA
6A ALEXANDRU PUSKIN STR.
TEL: +40 341 730280; FAX: +40 341 730281
e-mail: office@shipcare.ro
SEAMAN’S APPLICATION FORM
DATE: 11.10.19
RANK APPLIED FOR: ETO/Electrician
AVAILABLE FROM: 11.10.2019 VESSEL: Tanker
Insert th
NAME IN FULL: Galea Viorel relevant
DATE OF BIRTH: 25.09.2019 PLACE: Romania photo her
ADDRESS : Babadag City, Romania
E-MAIL ADDRESS: galeaviorel@gmail.com PHONE 074339604
FATHER: Ion MOTHER: Lenuta
CIVIL STATUS : MARRIED : x SINGLE: DIVORCED:
NEXT OF KIN: Galea Georgiana ADDRESS: Bucuresti
RELATIONSHIP: wife PHONE :0755677092
CHILDREN’ NAME IF ANY :
ENGLISH : GOOD x ADEQUATE POOR
PASSPORT No: 053913135 ISSUE:13.07.16 EXPIRE: 13.07.202
S. BOOK No: 35544ct ISSUE:26.04.18 EXPIRE: 12.04.202
GRADE OF NATIONAL LICENCE : Electro-Technical Officer
NO: 81008 ISSUE:26.04.2018 EXPIRES: 08.04.2
CERTIFICATES ISSUED BY ROMANIAN NAVAL AUTHORITY:
NAME OF DOCUMENT NO: ISSUE DATE EXPIRE DATE
ENDORSEMENT 67074 26.04.2018 08.04.2021
TANKERS CERTIFICATE
OIL TANKERS
CHEMICAL TANKERS
LPG

IMO VALID CERTIFICATES

NAME OF IMO COURSE NO ISSUE DATE EXPIRE DATE
PERSONAL SAFETY AND SOCIAL RESP. ON BOARD 1034 08.04.2016 08.04.2021
PERSONAL SURVIVAL TECHNIQUES 1034 08.04.2016 08.04.2021
ADVANCED FIRE FIGHTING 11718 11.04.2018 11.04.2023
MEDICAL FIRST AID 6757 08.03.2018 unlimited
PROFICIENCY IN SURVIVAL CRAFT AND RESCUE BOATS 14098 15.03.2018 15.03.2023
PREVENTION OF MARINE POLLUTION ON SHIPS
TRANSPORT AND HANDLING OF DANGEROUS CARGOES
MARITIME ENGLISH 2483 15.09.2016 unlimited
RADAR NAVIGATION, RADAR PLOTTING AND USE OF ARPA
GENERAL OPERATOR FOR GMDSS COURSE
GENERAL OPERATOR CERTIFICATE
BRIDGE/ENGINE TEAM & RESOURCES MANAGEMENT
ELECTRONIC CHART DISPLAY AND INFORMATION SYSTEM
SHIP SECURITY OFFICER
TANKER FAMILIARIZATION 4899 09.09.2016 09.09.2021
SPECIALIZED TRAINING FOR OIL TANKERS
SPECIALIZED TRAINING FOR CHEMICAL TANKERS

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 RO-RO PASSENGER SHIPS/PASSENGER SHIPS
SECURITY AWARENESS CERTIFICATE (SSA)

O T H E R NATIONALITY / A D D I T I O N A L D O C U M E N T S

E N D O R S E M E N T S E A M A N’ S B O O K
No NATIONALITY NUMBER ISSUE EXPIRE No NATIONALITY NUMBER ISSUE EXPIRE
1 1
2 2

OTHER DOCUMENTS ISSUE DATE EXP. DATE

YELLOW FEVER CARD NO: VALID 28.07.2016 28.07.2026
USA VISA NO: 20163O5875OO01 02.11.2016 30.10.2021
MCV VISA NO: 0059585710153 22.08.2017 21.08.2020

PREVIOUS SEA SERVICES

(please insert the last five voyages in chronological order, starting with the last one)

NAME OF THE YEAR OF RANK TYPE DWT OWNER/MANAGER ENGINE FROM TILL
VESSEL BUILD TYPE/HP
Cape Mahon 2007 Elec Cont 37901 Columbia Man B&W 14.11.20 27.03.2
cadet Shipmanagement Ltd (classic) 16 017
26274 hp
Cape Taft 2008 Elec Tanker 73400 Columbia Man B&W 25.07.20 26.01.2
cadet Oil/Ch Shipmanagement Ltd (classic) 17 018
emical 15153 hp
Cape Tampa 2008 Junior Tanker 73400 Columbia Man B&W 05.08.20 27.08.2
elect Oil/Ch Shipmanagement Ltd (classic) 18 018
emical 15153 hp
Sigma Triumph 2008 Junior Tanker 105291 NSB Reederei Man B&W 25.12.20 31.01.2
elect crude (classic) 18 019
oil 18176 hp
Sigma Triumph 2008 ETO Tanker 105291 NSB Reederei Man B&W 31.01.20 14.07.2
crude (classic) 19 019
oil 18176 hp

BANK DETAILS NOMINATED:

BANK’S NAME: ……Banca Comerciala Romana
ACCOUNT HOLDER: …Galea Viorel
IBAN CODE: RO82 RNCB 0904116905170008
SWIFT CODE: RNCBROBU

DECLARATION

I, the undersigned, hereby certify that I have furnished all above information in good faith with
the purpose of employment with your Company and that all the data is true and can be proven
against my original documents (Passport, Seaman’s book, professional certificates of discharge),
which I will produce at any time upon request by employing office, Master, Shipping Company
and/or authorized authority. Should any discrepancy from above stated arise, I will be fully
responsible for the resulting consequences, including, but not limited to, full charges and costs

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caused by such fact to involved parties for my employment and for immediate repatriation from
the ship.

SEAMAN’S SIGNATURE INTERVIEWED BY

_________________________ ____________________