t;")
l.-
Application Form
Position
Chief engineer
Position Applied for
Chief engineer
Lowest Position Acceptable
Date of Availabilitv
Personal Details
Section 2
Darweesh ahmed zuhier
Familv name / Surnome
Fint Name / Given Name Zeyad
Place-lattakia
Date -17-07-1981
Date & Place of Birth
Syria
Nationalily
Lattakia-syria
Permanent Address
Lattakia-syria
Present Address
4l SIZE
SAFETy SHOES SIZE I Large
I COVERALL
PPFI, information
Present Contact Number
Mobile Namber
Chief-engineer-zeyad
SKYPE ADDRESS
Enezvadl 98 1 @yahoo.com
Email Address
DAMASCUSlattakia
Nearest Airport (and Distance)
Passport
Section 3
Slria
Countrv of Issue
23-02-2012
Date Issued
Lattakia
Place Issued
006723950
Passport Number
22-02-2018
Passport -Expires
Seaman trook / Discharge book / Seaman Record Book / CDC
Section 4 ( hitight required )
as
Date Issued 31.01-2011
SyriaJattakia
Issuine Countrv & Place
Expirv Date (if anil, 30-01-20t7
2076
Number
Next of Kin -
Section 5 this is important information w€ require- Don't ignore it
Alaa darweesh
Full Name / Relations hip
Anv dependents / Children (incl age ) N/A
Lattakia-syria
Address
00s63992217216
Contact Numbers
STCW95 Ilishest Certificate of Competency / Licence Held
/ Dehils o! Limitations
Expiry
Dale Issaed
Issuing Country Certificale No,
Cla.\s
Graddcaoacih,
unlimited
Up date04- 31-12-2016
2870
Egvpt
Chief engineer
10-2012
WPIF _ M/OI Rev - 02
l2rH July 2011
STCW95 related Courses Attended and Certificates Obtained
Name of Course / Certificate STCW Code Cert No Expiry Date
Place lssue Date
W0Aluee
A-W1-1
Personal Survival Techniques Egvpt Updatel T- t0-09-2017
09-2012
Egpt
& Social Responsibility A-VI/ l -4 34633/l2lee
Personal Safety Update23- 17-09-2017
09-2012
A-Wl2-1
Proficiency in Survival Craft & Rescue ll45107lee Xxxxxx
Egvpt t6-04-2007
Boats
Proficiency in RESCUE CRAFTS
342lAluee
A-VI/
Advanced Fire Fighting Egrpt Updatel9- 12-09-2017
3
09-2012
Medical & First Aid Eglpt 35t7Tt2t
A-VU 4-1 Update26- 19-O9-2017
09-2012
/ HEALTH
Medical Certificate 1222
30-01-201 I 30-01-20't3
Syria
Certificat€
Drug and Alcohal test certificate Syria 05-12-2010
yfi &.Iru2
REFRESHER & UPDATING Eglpt 25-09-2012 35009112/eg 19-09-2017
References (Last Two Recent Emnlovers
Name Person to be contacted
Uae-abudhabi
Name Person to be contacted
Egvpt
Date...l7 -12-2012
l
WPIF,IWOI 12rH July 20l Rev - 02
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