"K" Line LNG Shipping (UK) Limited

6th Floor200Aldersgate Street

LondonEC1A 4HD
United Kingdom
Tel : +442032895727
Crew Department - Recruitment Group
Tel: +442032895727 - Email: marsean1980@gmail.com

(Passport Photo)

SEAFARER'S APPLICATION FORM - Page 1 of 3 - PERSONAL DATA

PERSONAL INFORMATION
Family Name Heydarov First Name (s) Zaur
Birth Date 10.01.1976 Birth Place Azerbaijan, Baku
Nationality Azerbaijani Religion Islam
Marital Status Married No. of Children No
Height (cm) 177 Weight (kg) 105
Nearest Airport H.Aliyev International Airport Alternative Airport Azerbaijan Kabala Airport
ADDRESS (include telephone country & area codes, advise also secondary or contact addresses if any)
Street & Nr. PIVZAVOD 28/3 Email Address zaur99@list.ru
Location Akhmedli Mobile Phone +994702259515
City Baku Residence Phone +994508891828
State, Country Azerbaijan Fax no
Postal (ZIP) Code 370027 P.O. Box (if any) no
NEXT OF KIN INFORMATION (person to contact in case of emergency & insurance beneficiary)
Family Name Heydarova First Name(s) Samira
Nationality Azerbaijani Relationship Wife
Street & Nr. PIVZAVOD 28/3 Email Address no
Location Akhmedli Mobile Phone no
City Baku Residence Phone no
State, Country Azerbaijan Fax no
Postal (ZIP) Code 370027 P.O. Box (if any) no
REMARKS
Requested Rank Chief Engineer Availability Date Any time
Prefer. Vessel Type OSV, PSV, TUG, DP Minimum Salary 5500
English Language Skills Spoken: fluent / good / average / poor - Written: fluent / good / average / poor
Other Foreign Languages Azerbaijani , Turkish ,Russian
Professional School / Academy Azerbaijan State Sea Technical School of Fish Industry - from 2003 to 2007
- Name & Period (From - To) Astrakhan State Technical University - from 2013 to up to now
Foreign Crew Experience Electrical Engineer
(specify nationalities)
Other Skills Computer, Microsoft Office Programs, Internet Programs

Further Remarks

Please advise how you heard Newspaper / Advert/ Google / Internet / Relative / Other Seafarer
about Kline Shipping: School / University / Other sources ……………………..
(underline appropriate option)
I hereby affirm that all the information provided by me in this application is true and correct to the best of my knowledge.
Date: 17.05.2016 Signature:
Note: This form can be returned per email without signature - please ensure however to send a signed printout for our records afterwards per
mail (e.g. with the passport photos and photo copies required). Please sign all 3 pages of the application form separately.

Crew Dept - (REC) - Tel: +447509756395- Email: marineshipping6@gmail.com

SEAFARER'S APPLICATION FORM - Page 2 of 3 - LIST OF DOCUMENTS

Please note that due to legal requirements employment is only possible once we are in possession of
electronic copies of your documents and licenses (please refer to the Cover Letter for further instructions).

Family First Rank

Name Name(s)
A. TRAVEL DOCUMENTS AND MEDICAL CERTIFICATES
Document Name (Description) Document Number Country Issue Place Issue Date Exp. Date
Passport P 4353063 Azerbaijan Ministry of 30.03.2011 29.03.2021
Internal
Affairs AZ.
Seaman's Book (national) 001431 Azerbaijan Azerbaijan 11.01.2014 11.01.2019
State
Maritime
Administrat
ion
Seaman's Book (flag state) N/A N/A N/A N/A N/A
Seaman's Book (flag state) N/A N/A N/A N/A N/A
Visa - United States (type C1/D) No No No No No
Visa - Others (Work/Reside. Permits) E212498020 Saudi Kingdom 14.10.15 14.04.2016
Extend the visit Arabia Of Saudi
2390069433 Arabia
Medical Examination Report 21503 Azerbaijan CJSC 08.01.2014 08.01.2019
Drug & Alcohol Test N/A N/A N/A N/A N/A
Vaccination against Yellow Fever 7737 Azerbaijan CJSC 31.08.2015 31.08.2020
Vaccination against Cholera N/A N/A N/A N/A N/A
Passport Photos please email a high quality copy of a recent passport photo.
B. CERTIFICATES OF COMPETENCY & ENDORSEMENTS, COURSE CERTIFICATES
- Deck & engine certificates & - radio certificates & endorsements - nav., deck, technical & management
endorsements (officers / ratings) - safety training (surv., fire, medical) courses (radar/ARPA, ISM, Marpol,
- electrical & reefer certificates - tanker courses (oil, chem., gas) Simulators, computer, welding etc.)
- cook & steward certificates - passenger vsl, roro, hazmat courses - any flag state certificates
Document Name (Description) Document Number Country Issue Place Issue Date Exp. Date
International Safety Management
SP-0136-13 Azerbaijan STCW 06.02.2013 31.01.2018
Code
Personal Survival Techniques
Fire prevention and Fire Fighting SO-0148-13 Azerbaijan STCW 28.01.2013 28.01.2018
Elementary First Aid
Proficiency in survival craft and
boats
SU-0051-13 Azerbaijan STCW 05.03.2013 13.02.2018
Medical First Aid SN-0396-13 Azerbaijan STCW 28.03.2013 01.03.2018

Training in advanced Fire-Fighting SJ-0844-13 Azerbaijan STCW 09.08.2013 26.07.2018

Ship Security-related training and

instruction
SI-0241-13 Azerbaijan STCW 04.04.2013 02.04.2018

Proficiency in survival craft and

boats other than fast rescue boats
SL-0367-13 Azerbaijan STCW 19.03.2013
25.02.2018

Engineer room resources

management
ER-0182-15 Azerbaijan STCW 23.06.2015 23.06.2020

constant
Hydrogen Sulfide Orientation Saudi
STCW 24.02.2016
Course Arabia KJO
High Voltage Electrical Equipment 0090/2016 STCW 01.04.2016
UKRAINE, 01.04.2021
ODESSA
DP SISTEM MAINTENANCE 12160406001 STCW 06.04.2016 ----
UKRAINE.
ODESSA
Date: Signature:
Crew Department (Recruitment Group) -Tel: +442032895727 - Email: marsean1980@gmail.com

SEAFARER'S APPLICATION FORM - Page 3 of 3 - SEA SERVICE (LAST 10 YEARS)

Please indicate your sea service in the last 10 years as exactly as possible - required are the actual sign-on and sign-off dates according to the service certificates resp. seaman's book entries. To speed
up processing kindly indicate phone and/or fax numbers of your previous employers. Ship sizes are to be indicated in gross tons, total engine output in kilo Watt (1 kW = 1.34 bhp) to go along with
STCW limitations. Please attach evidence for the listed sea service (copies of seaman's book entries, service certificates etc.). The information provided may be passed on to our clients and to flag
state administrations to allow for verification of rank experience. Please use the European date format (DD.MM.YY).

Family Name: First Name(s): Date of Birth:

Vessel's Name IMO No. Flag GT kW Ship Type Eng.Make Rank S/On Date S/Off Date Employer (company to contact for reference)
8515946 Azerbajian AHTS SULZER Chief
Ehram Khaliqov 2737 2 x 2647 6ZL40/48 Engineer
10.04.16 Up to now Caspian Shippig Co.LTD

SEA LION 9277046 Kuwait and TUG YANMAR Chief ARABIAN GULF MECHANICAL SERVICE
Saudi 2 x 1470 Supply 6M260-EN engineer
Arabia 1232 Boat 17.12.15 30.03.16 TO SAUDI

MR.MUTOH 9323259 Kuwait and 677 2 x 1103 OSV Caterpillar Chief 17.10.15 17.12.15 ARABIAN GULF MECHANICAL SERVICE
Saudi Arabi 3512B engineer
TO SAUDI

9397274 2 x 4639 DP 2
Rolls Roys
OSV 2-nd
Caspian Supplier 2900 N-5808 09.09.14 12.09.15 Topaz Marine Azerbaijan.
C25-33L8P engineer

9661209 Azerbaijan 2 x 1470 TUG 6L26HLX-Z

2-nd
SOCAR-1 200 P31 01.04.14 01.19.14 Caspian Shipping Co.LTD
NIGATA engineer
Qobustan 9581540 Azerbaijan 3 x 1081 CREW Caterpillar 2-nd 11.04.13 15.01.14 CMS
200 BOAT engineer
8423260 Azerbaijan 2 x 1558 AHTS SULZER
2-nd
Irgiz 593 8 ASL 15.01.08 28.03.13 Caspian Sea Oil Fleet
25/30 engineer

8423260 Azerbaijan 2 x 1558 AHTS SULZER

3-rd
Irgiz 593 8 ASL 11.07.07 12.01.08 Caspian Sea Oil Fleet
25/30 engineer
 8423260 Azerbaijan 2 x 1558 AHTS SULZER
4-rd
Irgiz 593 8 ASL 27.03.04 11.07.07 Caspian Sea Oil Fleet
25/30 engineer
Date: Signature: