1. WEMA-LAUDON GROUP APPLICANT’S PERSONAL DATA №
POSITION APPLIED FOR: 2 Off. DATE:
FIRST / LAST NAME: Igor Alexandrov CITIZENSHIP: Russian
FATHER’S NAME: Vladimirovich ADDRESS(INCL. POST CODE):196244 St.Petersburg
DATE OF BIRTH: 08/05/1960 Kosmonavtov Avenue, H.34 , Apt.4
PLACE OF BIRTH: Chelyabinsk region PHONE: +7 812 3782240 ; +7 9111788000
MARITAL STATUS: NEXT OF KIN:
IF MARRIED: Married DATE OF MARRIAGE: 21.01.1994
WIFE’S FIRST / LAST NAME : : Evgeniya RELATION:
Alexandrova
FATHER’S NAME : Albertovna FIRST / LAST NAME :
WIFE’S DATE OF BIRTH : 01.06.1968 FATHER’S NAME:
ADDRESS: 196244 St.Petersburg Kosmonavtov Avenue, H.34 , ADDRESS:
Apt.4
PHONE :+7 812 3782240;Mob:+7 911 178 8000 PHONE:
CLOTHES SIZES:
OVERALL 52 HEIGHT 177
SAFETY SHOES 42 WEIGHT 83
TROUSERS 52 COLOR OF EYES green
SWEATER 52 COLOR OF HAIR blonde
SHIRT 43
CHILDREN (IF APPLICABLE): 1 son
FIRST/ LAST NAME : DATE OF BIRTH :
Nikita Alexandrov 27.05.1994
MARINE EDUCATION RECEIVED
NAME OF SCHOOL TILL TYPE OF DEGREE RECEIVED
St.Petersburg Water Transport University 1987 Navigator
NATIONAL DOCUMENTS (RUSSIAN)
PASSPORT / SBK NO. ISSUED VALID
NAT.SEAMAN’S PASSPORT * MF 0183707 18.11.2005 18.11.2010
TRAVELLING PASSPORT 60 № 2918529 02.10.2002 02.10.2007
GRADE NO. ISSUED VALID
NAT.LICENCE: OOW Navigational 1010300204 22.06.2001 26.09.2008
ENDORSEMENT :OI L Chem 22.06.2001 26.09.2008
LPG
GMDSS: GO 0018753 -743/2001 22.06.2001 26.09.2008
ENDORSEMENT: 0018753 -743/2001 22.06.2001 26.09.2008
RADAR OBSERVER: IMO RES. A483 (XII) 0003049 21.10.2005 21.10.2010
ARPA : IMO RES. A482 (XII) 0007513 26.09.2003 26.09.2008
CERTIFICATE STCW CODE NO ISSUED VAILD TILL
BASIC SAFETY STCW ‘95 042831 30.09.2005 30.09.2010
PERS. SAFETY AND SOCIAL RESPONS. : A-V1/1-4 042831 30.09.2005 30.09.2010
ADVANCED FIRE FIGHTING : A-V1/3 025620 07.10.2005 07.10.2010
SURVIVAL CRAFT, RESCUE BOATS: A-V1/2-1 045540 07.10.2005 07.10.2010
MEDICAL EMERGENCY FIRST AID A-V1/4-1 004886 15.10.2005 15.10.2010
MEDICAL CARE CERTIF. A-V1/4-2 004886 15.10.2005 15.10.2010
HAZMAT B-V/4, B-V/5 16.12.2005 16.12.2010
HAZMAT (USA-TITLE 49) 16.12.2005 16.12.2008
OIL TANKER /SPECIALIZED/ PROGR. A-V/1, P.9-14
OIL TANKER /FAMILIARIZATION/ A-V/1, P.2-7
PROGR.
CHEM TANKER /SPECIALIZED/ PROGR. A-V/1,
P.16-21
CHEM TANKER /FAMILIARIZATION/ A-V/1, P.2-7
PROGR.
LIQUID GAS TANK /SPECIALIZED/ A-V/1,
PROGR. P.23-34
LIQUID GAS TANK /FAMILIARIZATION/ A-V/1, P.2-7
PROGR.
CRUDE OIL WASHING OPERATIONS/ INERT GAS SYSTEM
HEALTH CERTIFICATE 31.05.2010 31.05.2011
YELLOW FEVER 28.05.1998 28.05.2008
2. USA VISA (IF VALID)
PLACE OF ISSUE (CITY) FROM VALID TILL
St.Petersburg 17.10.2001 16.10.2003
FLAGS DOCUMENTS
LIBERIAN GRADE NBR ISSUED TILL PANAMANIAN GRADE NBR ISSUED TILL
SBK OOW 07328000 21.02.06 21.02.11 SBK
LICENSE OOW/2Off. 914507 21.02.06 21.02.11 LICENSE
GMDSS GMDSS
SPECIAL SPECIAL
CERTIFICATE CERTIFICATES
S
NIS DUTCH
SBK SBK
LICENSE LICENSE
GMDSS GMDSS
SPECIAL SPECIAL
CERTIFICATE CERTIFICATES
S
GERMA ANT&BARBUDA
N
SBK SBK OOW 00843 15.06.98 14.06.03
LICENSE DSN 14214 22.06.98 21.06.01
CYPRUS
SBK
LICENSE
OTHER DOCUMENTS (NOT MENTIONED BEFORE)
DOCUMENT GRADE NO. ISSUED VALID
SEA SERVICE LAST 10 YEARS
VESSEL’S NAME COMPANY (SHIP’S FLAG VSL’S GRT ENG. HP RANK EPLOY MENT TOT
OWNER OR SHIP’S TYPE TYPE M/Y M/Y AL
MANAGER) M
Christiane Schulte VORSETZEN/VBSK LIB CONT 26582 SZ 29330 2 Off. 12.05 05.06 4.8
KARTHAGO VORSETZEN/VBSK LIB CONT 14619 SZ 12180 2 Off. 10.03 05.04 6.7
KARTHAGO VORSETZEN/VBSK LIB CONT 14619 SZ 12180 2 Off. 10.02 04.03 5.9
P&O N.Takoradi VORSETZEN/VBSK LIB CONT 16800 SZ 13320 2 Off. 10.01 05.02 7.1
LISSY SCHULTE NAVIGO LIB CONT 16800 SZ 13320 2 Off. 08.00 03.01 6.5
LISSY SCHULTE NAVIGO LIB CONT 16800 SZ 13320 2 Off. 08.99 03.00 6.6
OPDR Cartagena NAVIGO Ant.Barb CONT 4115 PL 3960 2 Off. 07.98 01.99 6.4
Baltiyskiy 110 North West Sh.Co., RUS GENC 2300 SKL 1226 2 Off. 03.97 08.97 5.0
Volgo Balt 121 North West Sh.Co., RUS GENC 2457 6L275IIIN 1926 2 Off. 06.96 10.96 4.0
Smolny Baltic Tanker Co., RUS OILT 4510 RK 2991 2 Off. 01.93 02.96 11.0
Sormovskiy 3003 North West Sh.Co., RUS GENC 2780 LK 1302 2 Off. 05.87 10.92 52.0
SHIP OWNER’S DATA
COMPANY TEL/FAX CONTACT PERSON
CREW AGENCIES DATA
VESSEL CREW AGENCY TEL/FAX CONTACT PERSON
SIGNATURE OF SEAMAN: Igor Alexandrov OF SUPERINTENDENT: ____________________
