S . R SHIPPING (MYANMAR) CO.

, LTD
SEAFARER APPLICATION
( FOR RATING )
1. PERSONAL STATUS
APPLY SHIP : 1. BULK 2. TANKER 3. CONTAINER 4. ANY SHIP
APPLY RANK :
Within 3 Months
FULL NAME ( SAME AS PASSORT) AGE :
Photo
DATE OF BIRTH : PLACE OF BIRTH :
PRESENT ADDRESS :

CONTACT TEL, NO : RELIGION: SINGLE OR MARRIED

NEXT OF KIN : RELATIONSHIP : CHILDREN: ( )

HEIGHT : CM WAIST : IN WEIGHT : Kg OVER ALL SIZE:
EDUCATIONAL ATTAINMENT : COURSE - SHOES SIZE:
NAME OF SCHOOL : YEAR :
2. PERSONAL DOCUMENT
NAME OF DOCUMENT NO. DATE OF ISSUE DATE OF EXPIRY
PASSPORT
SIRB ( SEAMAN BOOK )

WATCH KEEPING CERTIFCIATE

BST, PSC
DSD, SSA
EDH
TANKER FAMILIZATION
COOK / FITTER CERTIFCATE
SID

3. FLAG ENDORSEMENT
FLAG GRADE NO. DATE OF ISSUE DATE OF EXPIRY
PANAMA
Antigua & Barbuda
KOREA COC
OTHERS
4. VISA GRADE NO. DATE OF ISSUE DATE OF EXPIRY
USA
AUSTRALIA
OTHERS

ကု မၸဏီသို ႔ ဆက္သြယ္ေပးသူ ၏ အမည္ : _______________________________

5. SEA SERVICE RECORD
K / SHIP T / ENG SIGN - ON TOTAL SEA MIXED CREW STATUS
NAME OF VESSEL RANK REASON MYANMAR AGENT
G. R. T K.W SIGN - OFF SERVICE OFFICER RAITING

This form is to use accordance with

SRS QP 02 - Section 5.1.2 recruitment
I HAVE ABOVE MENTIONED FOR APPLICATION OF MYSELF ( SEAMAN ) WRITING AND THE SUBMITTED DOCUMENT ARE TRUE &procedure and 5.6 Record
1/Application Form
GENUINE FOR ORIGINAL COPY 2/Crew manager' designated Staff
3/Designated Cabinet // Crew
department
4/2years
DATE : SEAMAN SIGNATURE : 5/Destroy before Disposal
with
tment

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