Security Medical

*. PERSONAL DETAILS

RANK MOTORMAN ALTERNATIVE RANK (IF ANY) ASSISTAN MECHANIC

LAST NAME EMCHE FIRST NAME MATEUSZ

OTHER NAMES ADAM NATIONALITY POLISH

SEX M F BIRTH PLACE SZCZECIN DATE OF BIRTH 4.09.1993 MARITAL STATUS SINGLE COLOUR OF EYES BLUE COLOUR OF HAIR

MOTHER’S NAME MARIANNA FATHER’S NAME RYSZARD

HEIGHT (CM) 173 WEIGHT (KG) 79

INTERNATIONAL AIRPORT (NEAREST TO HOME TOWN): GOLENIÓW AVAILABLE FROM: 22.07.2017

2. ADDRESS

STREET OSIEDLE KASZTANOWE 55 E/7

POST CODE 70-895

CITY SZCZECIN

COUNTRY POLAND

TEL. NO. 606-415-795

E-MAIL ************@*****.***

3. NEXT OF KIN

FULL NAME RYSZARD EMCHE RELATION FATHER

ADDRESS OSIEDLE KASZTANOWE 55 E /7 DATE OF BIRTH 14.02.1966 CITY SZCZECIN COUNTRY POLAND

TEL. NO. 530-833-450 MOBILE PHONE NO. FAX NO.

4. BENEFICIARY IN CASE OF DEATH

FULL NAME RYSZARD EMCHE RELATION FATHER

ADDRESS OSIEDLE KASZTANOWE 55 E/7

CITY SZCZECIN COUNTRY POLAND

TEL. NO. 530-833-450 MOBILE PHONE NO. FAX NO.

5. TRAVEL DOCUMENTS

DOC./VISA TYPE DOC./VISA NO. ISS.DATE EXP. DATE ISS. BY (AUTHORITY) PLACE OF ISSUE PASSPORT EJ 1268073 4.08.2015 4.08.2025 WOJEWODA

ZACHODNIOPOMORSKI

SEAMAN BOOK 259670 11.06.2013 31.12.2018 URZĄD MORSKI W SZCZECINIE

US C1/D VISA 21.06.2016 16.06.2026 WARSAW

6. EDUCATION

SCHOOL NAME AKADEMIA MORSKA W SZCZECINIE FROM 2012 TO 2017 APPLICATION

7.COURSE NAME ISSUE DATE

EXPIRY

DATE

ISSUED BY (AUTHORITY) ISSUED AT

PERSONAL SURVIVAL 6.07.2017 5.07.2022 URZĄD MORSKI WSZCZECINIE BASIC FIRE FIGHTING 6.07.2017 5.07.2022 URZĄD MORSKI WSZCZECINIE ADV. FIRE FIGHTING 6.06.2017 5.06.2022 URZĄD MORSKI WSZCZECINIE ELEMENTARY FIRST AID 6.07.2017 5.07.2022 URZĄD MORSKI WSZCZECINIE MEDICAL FIRST AID 5.06.2017 VALID

INDEFINITELY

URZĄD MORSKI WSZCZECINIE

PERS. SAFETY & SOC. RESP. 6.07.2017 5.07.2022 URZĄD MORSKI WSZCZECINIE PROF. IN SECURITY-

AWARENESS

16.12.2013 VALID

INDEFINITELY

URZĄD MORSKI WSZCZECINIE

CERT.OF PROFI. FOR

SEAFARERS WITH

DESIGNATED SECURITY

DUTIES

16.12.2013 VALID

INDEFINITELY

URZĄD MORSKI WSZCZECINIE

CERT. OF TR. IN OIL AND

CHEMICAL TANKER

FAMILIARIZATION

18.12.2015 VALID

INDEFINITELY

URZĄD MORSKI WSZCZECINIE

CERT. OF TR. IN LIQUFIED GAS

TANKER FAMILIARIZATION

18.12.2015 VALID

INDEFINITELY

URZĄD MORSKI WSZCZECINIE

OTHER CERTS

CERTIFICATE OF TRAINING IN

OPERATION AND MAINTENANCE

OF POWER SYSTEMS IN EXCESS

OF 1 Kv

30.03.2017 VALID

INDEFINITELY

URZĄD MORSKI WSZCZECINIE

8. ENGLISH PROFICIENCY

FLUENT V. GOOD GOOD x FAIR POOR

COMPANY

NAME

VESSEL NAME

VESSEL

TYPE

FLAG GRT KW RANK SIGN ON SIGN OF

Unity Line

Limited Sp. z

o.o., oddział w

Polsce

m/f Wolin Ferry bahamas 228**-***** Eng.appr. 13.02.2014 13.03.2014 Akademia

Morska w

Szczecinie

m/s Nawigator

XXI

School

science

research

polska 1245 1120 Eng/cdt 20.10.2014 9.11.2014

Polska Żegluga

Morska - Polish

Steamship

Company

m/v Roztocze Bulk carrier bahamas 24109 7368 Cadet engine 10.07.2016 30.11.2016

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