STATEMENT OF CONSENT

for processing of personal data

I, _________________________________________________________________________

at the following address: _________________________________________________________________

series _____ issued by _______________________________________________

(
on the Federal Law of the Russian Federation give consent
to FSBI of Primorsky region and
Port and Flag State Control Directorate branch
str., 29, Moscow, 105118, Russia) to process my personal data.
Personal data that I give my consent to process includes:
- surname, name and patronymic, date and place of birth, citizenship;
- data included in qualification documents (certificates of competence, endorsements attesting
the recognition of certificates, certificates of proficiency, tanker endorsements (for oil, gas and chemicals),
test reports);
- information of identity documents;
- information regarding education, profession, qualification level, professional experience;
- e-mal address.
authorized
representatives in the form of Port and Flag State Control Directorate

to qualification documents issued by harbor master of seaport of the Russian Federation and

using automation tools, implementing the necessary actions established by law

regarding personal information, including its collection, recording, systematization, accumulation,
storage, clarification (updating and editing), extraction, use, transfer (distribution, provision, access),
depersonalization, blocking, deletion and destruction of personal data in compliance with the requirements
of its confidentiality and ensuring the safety of information during its processing.
Automated processing of my personal information (with my consent) is carried o
State Control Directorate as the

The processing of personal data with my consent is carried out through data obtained from
documents provided by either me personally (or my authorized representative) or an application
(statement).
This statement of consent is issued without limitations of validity.
The revocation of this consent is arr
in the form of Port and Flag State Control Directorate the original statement of
revocation or its copy, directly or through the following e-mail: diplom@marinet.ru.

_________________________ ________________________ _____________________

(signature) (full name) (date)