Document ID: 31ef26bb-f7a9-48a9-91d9-a50e90e53694



 



  

  

    OILER
    
   DIANA 
     SERGEY
    
   
  
 


 
      
    
      

     

    

 
     
    
   
   
   
   
   

   
   



  








          
    
          
 

         
 

         
 

        



TOTAL SEA SERVICE 4 YEARS SEAMAN'S SIGNATURE V

DATE OF INTERVIEV 05.11.2023 


  



Document ID: 31ef26bb-f7a9-48a9-91d9-a50e90e53694

 DECLARATION AGAINST USE OF DRUGS AND ALCOHOL

SEAMAN'S NAMΕ NEDENKO SERHII

S. BOOK No. AB 622386

RANK OILER

VESSEL TO JOIN ZAGORI

Hereby declare that:

1. I am not a habitual user of any drugs other than those which at times are
prescribed to me by a registered medical practitioner.
2. I will not take any drugs whilst serving on board unless prescribed by ship's
medical officer or a medical practitioner appointed by the Master or his Agents.
3. I agree without any reservations whatsoever to submit myself to random testing
for usage of drugs, or misuse of alcohol which may be ordered by the Master or
the company within the scope of Company's drug and alcohol policy.
4. I have been made fully notified of the Company's policy on drug and alcohol.
5. I have not at any time presently or in the past willfully or otherwise consumed,
traded, trafficked or handled illegal drugs.
6. I agree that possession, use and trafficking of drugs and breach of Company's
Drug and Alcohol Policy will be just causes for termination of my employment
with replacement at my cost.
7. I fully agree to cooperate with U.S Drug Enforcement Agency, regarding the
implementation of provisions contained in the Sea Carrier Security Manual.

Above declaration has been made by me truthfully without duress and of my own
free will on this day.

Signature of the seaman: V

NEDENKO SERHII
The seaman's name in capital letters:

Form: DD-08 Issued by : Adriatico STO Revision 01 Page 1 of 1

Document ID: 31ef26bb-f7a9-48a9-91d9-a50e90e53694

 SEAFARER NEXT OF KIN DETAILS FORM

NEXT OF KIN

Seafarer Details :

Seaman’s Full Name NEDENKO SERHII

Date of Birth 27.02.2000

Vessel to Join ZAGORI

Ship Owner/ Ship Manager HELICON SHIPPING ENTERPRISES LTD.

Rank OILER

Home Address 16, VESELAYA STR. , IZMAIL, ODESSA REG.,

UKRAINE, 68601
Personal Telephone Number +380680485181

Next of Kin Details :

Next of Kin Full Name NEDENKO DIANA

Relationship
MOTHER
Date of Birth 09.01.1978
Home Address ( Registration ) 16, VESELAYA STR., IZMAIL, ODESSA REG.,
UKRAINE, 68601

Home Address ( Actual )

Telephone Number +380680485184

Other Relevant Comments or Remarks :

V 08.11.2023
Seaman’s Signature : _____________________________ Date : __________________

NEDENKO SERHII
Seaman’s Name in Block Letters : ____________________________________________

Document ID: 31ef26bb-f7a9-48a9-91d9-a50e90e53694

 RECEIPT OF COMPANY POLICY STATEMENT AND / OR FAMILIARIZATION SHEET
HELIKON SHIPPING ENTERPRISES

Seafarer’s Name NEDENKO SERHII

Nationality UKRAINE

Date of Birth 27.02.2000

Rank OILER

Vessel ZAGORI

The above named individual received the following information/ instructions:

Item Yes / No

Health, Safety and Environmental Protection Policy YES

Drug and Alcohol Abuse Policy YES
Training Policy YES
Privacy Policy YES
Harassment and Bullying Policy YES
MLC 2006 Seafarer Declaration (Form No.: P19 Version 05.01) YES
Internet Access Seafarer Declaration YES
Certificate of Attendance “In House Training (ISM)” (Adriatico Crewing Form FD-03B) YES
Confirm that Master is familiar with “The EU MRV Monitoring, Reporting, Verification
(SMSM 14.8)” and whole SMSM Section:14 “Procedures & Instructions, Environmental N/A
Protection”
Confirm that all crew members receive IMO Standard Marine Communication Phrases
Booklet (electronic free version) and strongly recommended to study it and use it on YES
board.
Certificate of Attendance “In House Training (SMCP)”. This training will be conducted
with crew members whose English level is poor or very average and can’t be raised by YES
themselves. (Adriatico-Crewing Form FD-03c)

Name and signature of crew manager: Gkikas Konstantinos

V
Seafarer’s Signature:
08.11.2023
Date:

Form: DD-03e Helikon S.E. Issued by : STO Revision : 02 Page 1 of 1

Document ID: 31ef26bb-f7a9-48a9-91d9-a50e90e53694

 I, NEDENKO SERHII
hereby agree to give my personal data to my employer ZAGORI NAVIGATION S.A.
and their managers PAVAR NAVIGATION INC and their General Agents Helikon Shipping
Enterprises Ltd in order to enable them administer a relationship with me and to ensure that
maritime legislation and their Company requirements are met. I am also aware that due to
the nature of my employment my personal data can be transferred to third parties like the
employer's representatives, banks and/or financial service companies, brokers, charterers,
port authorities, consular authorities of foreign countries, port agents, the administrations of
the flags of the ships, representatives of the transport companies, insurance underwriters,
and P&I clubs.
Additionally, I am informed about my rights under General Data Protection Regulation
(GDPR) (EY) 2016/679 regarding the processing and storage of personal data:

• The right to rectification, erasure, restriction, objection;

• The right to date portability;
• The right to withdraw consent at any time;
• The right to lodge a complaint with a supervisory authority:

Seafarer’s Signature: Date: 08.11.2023

V

Document ID: 31ef26bb-f7a9-48a9-91d9-a50e90e53694

 Helikon Shipping Enterprises Ltd.
Issued by: PR SAFETY MANAGEMENT SYSTEM MANUAL Issue No.:
05.01
Form Title: MLC2006 SEAFARER DECLARATION Form No.: P19

(This form should be forwarded to HELIKON SHIPPING by the M anning Agent)

YES NO
All items contained in my employment contract/agreement have been YES
1
explained to me and I am aware of them.
2 All the certification that I have furnished are genuine. YES
A full sample agreement incorporating all terms and conditions to apply YES
3
(including the CBA) has been provided to me prior to entering the agreement.
I was given adequate time to review the contract and seek advice on the YES
4
terms and conditions in the agreement
I freely entered into the agreement with a sufficient understanding of my YES
5
rights and responsibilities.
I was given an original set of my Seafarers Employment Agreement, which I YES
6
must carry with me on board.
No fees or other charges for my recruitment or placement or for providing YES
7
employment to me have incurred directly or indirectly, in whole or in part.
No joining advances or any other exploitation incurred with regard to the YES
8
employment.
The company’s Complaint procedure has been explained to me and I am fully YES
9
aware of the process to be followed and the record to be used.
The terms and conditions of employment and any particular conditions YES
10
applicable to the job for which I am engaged have been explained to me.

By ticking the YES box you indicate that the documented statement is correct.
By ticking the NO box you indicate that the documented statement is NOT
correct.
If any statement is answered NO you may enter your remarks below.

REMARKS:

                   
           

NEDENKO SERHII
Full name of the seaman: ____________________________________________________________

OILER
Rank: ____________________________________________________________________________

ZAGORI
Vessel: ___________________________________________________________________________

Signature of Seaman: V________________________________________________________________

08.11.2023
Date: _________________________________ Odessa, Ukraine
Place: ______________________________________

Page 1 of 1
Document ID: 31ef26bb-f7a9-48a9-91d9-a50e90e53694
 CERTIFICATE OF ATTENDANCE

This is to certify that

Mr. NEDENKO SERHII

27.02.2000
Date of Birth

Rank OILER

Have received electronic materials for improvement English Language knowledges

Employer HELIKON SHIPPING ENTERPRISES LTD

Subject of Training IMO Standard Marine Communication Phrases
Training Materials - SMCP Electronic version
Date 08.11.2023
Remarks

I hereby declare that will use received information to improve my skills and knowledge in English language.
Seafarer's Signature V

Form: FD 03c Issued by : Adriatico STO Revision 01 Page 1 of 1

Document ID: 31ef26bb-f7a9-48a9-91d9-a50e90e53694

 DATE: 08.11.2023

SEAMAN: NEDENKO SERHII

S.BOOK: AB 622386

SHIP: ZAGORI

I hereby declare that I have been fully informed about the cost of using unlimited
internet access on board which is USD 35 per month and I agree to use it and be
charged/debited for this amount every month.

V
----------------------------------

Signature

Document ID: 31ef26bb-f7a9-48a9-91d9-a50e90e53694

 WARNING and DECLARATION of COMPLIANCE and RESPONSIBILITY
You are reminded that, for all seamen joining ships manned through this Agency, the consumption or
procession or making of ALCOHOL beverages is prohibited during you trip to the airport, stay in hotel in
Kiev, passing the COVID PRC Test, in airport, in flight, until boarding the ship, during your service
onboard the ship or your stay in port, and in the same legs of your trip of returning home.
Violation of this rule is a very serious offence and will result (as per C.B.A., S.E.A., and Company’s
ISM/SMS) to your dismissal (sign off) and you will be liable to pay your repatriation expenses and the
expenses for your replacement as well.
Airlines are strict and they may prohibit you to continue your flight because of drunkenness.
If you are sure, prepared and able to be disciplined and obey this rule, sign the Declaration below.

NEDENKO SERHII
The Undersigned (Name)……………………………………………………………………………………
ZAGORI
Proceeding to join MV………………………………………………………………………………………..
08.11.2023
Date………………..………

Hereby declare that I totally agree with the above and I confirm compliance.

Signature and Name

V
-----------------------------------------------

ПОПЕРЕДЖЕННЯ та ДЕКЛАРАЦІЯ ЗГОДИ та ВІДПОВІДАЛЬНОСТІ

Нагадуємо Вам, що для всіх моряків, що йдуть на судна, які обслуговуються через цю Агенцію,
споживання, обробка або виготовлення алкогольних напоїв заборонені під час Вашої подорожі до
аеропорту, перебування в готелі у Києві, проходження ПЦР тесту на КОВІД, в аеропорту, під час
перельоту на борту літака, на борту судна та на березі під час Вашої служби та такі ж заборони
діють під час Вашої подорожі по поверненню додому. Порушення цього правила є дуже
серйозним правопорушенням, і це призведе (згідно з C.B.A., S.E.A. та ISM / SMS компанії) до
Вашого звільнення (списання з судна), і Ви будете зобов'язані сплатити витрати на репатріацію та
витрати на заміну.
Така ж заборона застосовується з моменту підписання Вашого контракту (S.E.A.) і на час подорожі з
дому до аеропорту, в аеропорту (аеропортах), під час польоту та поїздки додому.
Авіакомпанії суворі, і вони можуть заборонити Вам продовжувати переліт через пияцтво.
Якщо Ви впевнені, підготовлені та здатні бути дисциплінованим і виконувати це правило,
підпишіть декларацію нижче.

NEDENKO SERHII
Я, що нижче підписався (ім'я) …………………………………………………………………………………………
ZAGORI
Запланований йти на судно …………………………………………………………………………………………… ..
08.11.2023
Дата………………..………

Цим заявляю, що повністю погоджуюсь із вищезазначеним та підтверджую свою згоду.

Підпис та ім'я
V NEDENKO SERHII
-----------------------------------------------

Document ID: 31ef26bb-f7a9-48a9-91d9-a50e90e53694

 PANDEMIA DECLARATION and REPATRIATION POSTPONMENT

I, the undersigned seafarer hereby declare that the Agency, on behalf of the Owners of the ship, has
explained to me very clearly that:
I am joining the ship during a GLOBAL PANDEMIA (COVID-19) and when I complete my contract and
resign, there is a strong possibility that my replacement will not be possible due to the PANDEMIA local
lockdowns – quarantine – crew change restrictions or prohibitions in countries /ports where the ship
calls at.

As I have fully understood the difficulties of the PANDEMIA situation, I clearly declare that In such case, I
will not refuse to postpone my repatriation and extend my contract accordingly up to the time the ship
calls at a country/port, where the crew replacements are possible.

NEDENKO SERHII
Name of Seafarer____________________________

V
Signature___________________________________

08.11.2023
Date_______________________________________

Ship to Join__________________________________
ZAGORI

ДЕКЛАРАЦІЯ В ЗВ’ЯЗКУ З ПАНДЕМІЄЮ ТА І ВІДТЕРМІНУВАННЯ РЕПАТРІАЦІЇ

Я, моряк що підписався нижче, заявляю, що Агентство від імені власників судна дуже чітко
пояснило мені, що:
Я наймаюсь до судна під час ГЛОБАЛЬНОЇ ПАНДЕМІЇ (COVID-19), і коли я закінчую свій контракт і
подаю у відставку, існує велика ймовірність того, що моя заміна буде неможливою через місцеві
блокування ПАНДЕМІЧНИХ локдаунів – карантину, обмеження чи заборони на зміну екіпажу в
країнах / портах, куди заходить судно.

Оскільки я повністю зрозумів труднощі ситуації з ПАНДЕМІЄЮ, я чітко заявляю, що в такому

випадку я не відмовлюся відкласти свою репатріацію і продовжую свій контракт відповідно до
моменту заходу судна в країну / порт, де відбувається можливою зміна екіпажу.

Ім'я моряка ______________________________

NEDENKO SERHII

V
Підпис ___________________________________

08.11.2023
Дата______________________________________

Назва судна _______________________________

ZAGORI

ÌAIÇj&È6ADÇ*8fÎ

Document ID: 31ef26bb-f7a9-48a9-91d9-a50e90e53694

 SEAFARER RELATIVES ALLOTMENT FORM

SEAFARER RELATIVES ALLOTMENT FORM

BENEFICIARY BANK PJSC RAIFFEISEN BANK AVAL

BANK BRANCH ADDRESS 20/1, MIRA PROSPRKT, IZMAIL, ODESSA REG., UKRAINE, 68601

SWIFT CODE AVALUAUK

BENEFICIARY NAME NEDENKO DIANA
BENEFICIARY ACCOUNT NUMBER UA903808050000000026204833123
BENEFICIARY ADDRESS 16, VESELAYA STR. , IZMAIL, ODESSA REG., UKRAINE, 68601

DEUTSCHE BANK TRUST COMPANY AMERICAS, 60 WALL STREET,

INTERMEDIARY BANK 10005 NY, USA

SWIFT CODE INTERMEDIARY BANK BKTR US 33

Details of payment : “NON-COMMERCIAL TRANSFER”

SEAMAN NAME NEDENKO SERHII

INFO ADDRESS 16, VESELAYA STR., IZMAIL, ODESSA REG., UKRAINE

POST CODE 68601

PLACE OF BIRTH ODESSA REG., UKRAINE

CITIZENSHIP & NATIONALITY UKRAINIAN

RELATIVE NAME NEDENKO DIANA

INFO ADDRESS 16, VESELAYA STR., IZMAIL, ODESSA REG., UKRAINE

POST CODE 68601

PLACE/DATE OF BIRTH IZMAIL, ODESSA REG., UKRAINE / 09.01.1978

CITIZENSHIP & NATIONALITY UKRAINIAN

RELATIONSHIP WITH MR. NEDENKO SERHII MOTHER

Form: DD-07 Issued by : Adriatico STO Revision 00 Page 1 of 1

ÌAIÇj&È6AD870xÎ
Document ID: 31ef26bb-f7a9-48a9-91d9-a50e90e53694
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Document ID: 31ef26bb-f7a9-48a9-91d9-a50e90e53694

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Document ID: 31ef26bb-f7a9-48a9-91d9-a50e90e53694