TO: ONE SHIPPING, TOKYO

FM: ONE SHIPPING, MANILA DATE :

RE: APPLICANT'S BIO-DATA INTENDED VESSEL:

REFERENCE FAX NO.

NAME: BIRTH DATE :

POSITION : DECK CADET AGE : CIVIL STATUS:
SEAMAN'S BOOK NO.: VALIDITY: SHOE SIZE:
PHIL. PASSPORT NO.: VALIDITY: CLOTHING SIZE:
PHIL. LICENSE NO. : DATE OF ISSUE:
PANAMA LICENSE/RATING CERT. : VALIDITY:
OTHER LICENSE/SEAMAN'S BOOK : VALIDITY:
Blood Pressure (Systolic) mmHg fit to work (Diastolic) mmHg fit to work Pulse rate /mi fit to work
Any P&I Claim within 3 years? NO Any operation/sickness within 3 years? NO Any maintenance medicine?NO
Medical history: NO
PRESENT ADDRESS: TEL.:
TEL.:

SOLAS NUMBER DATE OF ISSUE DATE OF EXPIRY

MEDICAL CARE
MEDICAL EMERGENCY FIRST AID
ADVANCED TRAINING IN FIRE FIGHTING
PROFICIENCY IN SURVIVAL CRAFT & RESCUE BOAT

STCW CERTIFICATE
STCW ENDORSEMENT
BASIC TRAINING

DECK OFFICERS/CREW
RADAR OBSERVER COURSE
RADAR SIMULATOR COURSE
ECDIS ( SHIP/TYPE SPECIFIC ) JAN-9201/7201
ECDIS ( SHIP/TYPE SPECIFIC ) JAN-701B/901B
ECDIS ( GENERIC)

DECK OFFICERS

SHIP'S RADIO TELEPHONE OPERATOR

GMDSS
SATELLITE COMMUNICATION COURSE
GEN. OPERATOR'S COURSE
PANAMA GMDSS

PHYSICAL INSPECTION
SEA EXPERIENCE: (LAST FIVE YEARS STARTING FROM LAST VESSEL)

POSITION NAME OF VESSEL TYPE/GROSS TONS FROM TO AGENCY

ENGINE TYPE/H.P. DD/MM/YY DD/MM/YY

FOR YOUR KIND APPROVAL/REFUSAL DOCTOR'S CONSULTATION ONBOARD

SICKNESS :
RECOMMENDED BY : RELATIONSHIP :