Rev 04 03-01-2022 KRFA

I. PERSONAL INFORMATION

NAME: Diosdado L. Libato DATE OF BIRTH: oct. 12 , 1974

POSITION APPLIED: 3AE AGE: 49
LICENSE: CE PERMANENT ADDRESS: mahayahay st. bernard so. leyte
CIVIL STATUS: married PRESENT ADDRESS: mahayahay st. bernard so. leyte
if Married pls input spouse name and chlildren / if single pls input parents names and siblings
Name Age: Present Address Occupation
salvacion b. libato 46 mahayahay house wife
joshua b. libato 21 st. bernard so. student
juaquin iñgo b. libato 19 leyte student
james dylan b. libto 16 student

II. SUMMARY OF SEA SERVICE RECORDS

Please arrange from recent to oldest onboard experience
NAME OF VESSEL TYPE OF VESSEL GRT KW POSITION/RANK
nine frontier woodchip 49,720 9,480 3ae
anemona woodchip 39,895 8,580 3ae
kagara bulk 41,963 9,170 3ae
clipper iwagi log ship 17,009 5,850 3ae
malto hope log ship 17,019 5,850 3ae
ocean bloom log ship 23,264 7,860 3ae
malto elan log ship 3ae
global round log ship 6,200 3ae
anemona woodchip 39,895 8,580 3ae

III. HEALTH INFORMATION REFERENCE

ANSWERS:

Do you have any

medicine
none
maintenance ? specify ?
since when?

Do you have any history

none
 none
If yes, give details.

IV. SUMMARY OF DOCUMENTS

DOCUMENTS DATE OF ISSUANCEDATE OF EXPIRATION
SIRB (SEAMAN'S BOOK) jul. 14, 2016 jul.12, 2026
COP jul. 27, 2021 jul.27, 2026
ID LICENSE/SID/COC: aug. 16, 2021 aug. 16,2026
DCOC
PEME
Domestic quarantine yellow card (If Cook):
Covid 19 Vaccine: (please indicate brand) astrazinica

V. CONTACT PERSON IN CASE OF EMERGENCY: Next of KIN Please complete

NAME RELATIONSHIP ADDRESS CONTACT NO. : 9991727732

salvacion b.libato wife mahayahay st. bernard so. leyte

VI. OTHERS ANSWERS:

SALARY DESIRED/ Salary Range :
DOCUMENTS VALID AND ON HAND? (YES or NO)
Availability for onboard any time

Note: Attached recent picture

and electronic copy of your SIRB, COP/COE/COC/DCOC ,ID License/SID and Certificate
 MORETA SHIPPING LINES INC.
ONLINE APPLICATION FORM

Mobile No.: 9286301748

Viber No:
ahay st. bernard so. leyte EMAIL ADDRESS: libatodiosdado7@gmail.com
ahay st. bernard so. leyte

PERIOD COVERED FOR ENGINE APPLICANTS

FROM TO
TRADE AREA MAIN ENGINE MAKER AND MODEL
(mm/dd/yy) (mm/dd/yy)
10-Jul-2011 04 2012 world wide mitsui man B&W 6s50mc
oct.13. 2012 28 jul. 2013 world wide mitsui man B&W 6s50mc
dec.24 2013 nov.262014 world wide mitsui man B&W 6s60mc
12-Mar-2015 22-Jan-2016 world wide makita man b&w 6s42mc
oct 19 2016 jul 03 2017 world wide makita man b&w 6s42mc-c
nov. 26 2017 may 30. 2018 world wide makita mab b&w
26-Sep-2018 jun 9 2019 world wide
dec 12 2019 dec 22,2020 world wide
oct. 10, 2021 oct.10, 2022 world wide mitsui man B&W 6s50mc
/SID and Certificate of Sea Service issued by Last Employer.
NC.
RM

FOR ENGINE APPLICANTS

FOR ENGINE APPLICANTS (Chief Engineer & Third Engineer)
FOR ENGINE APPLICANTS (Chief Engineer & Th
strokes of main engine GENERATOR ENGINE AND MAKER/MODEL STROKES OF GENERATOR
2 stroke daihatzu 4 stroke
2 stroke daihatzu 4 stroke
2 stroke daihatzu 4 stroke
2 stroke yanmar 4 stroke
2 stroke yanmar 4 stroke
2 stroke yanmar 4 stroke
2 stroke yanmar 4 stroke
2 stroke yanmar 4 stroke
2 stroke daihatzu 4 stroke
PLICANTS (Chief Engineer & Third Engineer)
EMPLOYER
mmpi
mmpi
mmpi
mmpi
mmpi
mmpi
moc
moc
mmpi