Safety Management System Manual

Seaport International Shipping Co. LLC Form 02: Application Form Of

Seafarers

Revision: 04 Page: 1 of 3 Date: 10 - September - 2014

Prepared By: DPA Approved By: MD

FORM #: 02

APPLICATION FORM OF SEAFARERS

Position Applied Captain - Master none limitation [pic]

License STCW Code II/2-102******* valid 12.03.2018

Issued Harbour master port of ARKHANGELSK

Surname Zinkin

Name Dmitry

Date of Birth 02.09. 1955

PASSPORT DETAILS

PP #Travel Date of Issue Date of Expiry

passport

64N5577509 30.03. 2012 30.03. 2017

SEAMAN PASSPORT ( BOOK) DETAILS

Seaman Identity Date of Issue Date of Expiry

Document

RUS 01536672 02.09. 2013 02.09.2018

Please provide details of if holding any other Seaman Books (i.e. Panama,

Liberian, etc..) No, Issue, Expiry

1. Seaman Book - Antigua&Barbuda,MASTER Certif-s - Antigua&Barbuda issued

in Hamburg- Expiry

2.

3.

OTHER RELEVANT DETAILS

Marital Status Marride Coverall size 54-56

Contact # mob 07-915-***-**-** Safety shoe size 42-43

phone

Fax / Email acf5ug@r.postjobfree.com Waist size 90

Address: 8/4-103 2-ay Pugachevskaya str. Moscow mob. phone

07-915-***-**-**

Sister E-mail: acf5ug@r.postjobfree.com mob. Phone 07-910-***-**-**

Next of Kin name, Address & Contact #: Elfert Nelly - sister 26/2-99

Bolshayay Cherkizovskaya str. Moscow home phone Sister

E-mail: acf5ug@r.postjobfree.com mob. phone 07-910-***-**-**

Details of children: Name / Age

1) Maria Zinkina / dauther / three year.

2)

3)

4)

LICENSE DETAILS

LICENSE DATE DATE PLACE STCW 95 CODE REMARKS

ISSUE EXPIRE ISSUE

Master 102******* 19.08.1 12.03.1 Arkhangels II/2 None limitation

4 8 k

Tanker 10.04.1 10.04.1 Moscow A -V/ 1 N199644

familiarisation 3 8

Advanced tanker 10.04.1 10.04.1 Moscow A -V/ 1 N199644

operation 3 8

?rude oil washing 10.04.1 10.04.1 Moscow A -V/ 1 N199644

3 3

Tanker safety 10.04.1 10.04.1 Moscow A -V/ 1 N199644

3 3

All information contained in this document is property of Seaport

International Shipping., and should not be divulged in whole or part to any

Company or person, without the prior written permission of Seaport

International Shipping.

Safety Management System Manual

Seaport International Shipping Co. LLC Form 02: Application Form Of Seafarers

Revision: 04 Page: 2 of 3 Date: 10 - September -2014

Prepared By: DPA Approved By: MD

NAME: RANK:

CERTIFICATE STATUS

Certificate Cert. # Date issued Date Expire Place Issue STCW Code Remarks

Medical First Aid 404707 29.03.13 29.03.18 Moscow A-VI/ 4-1

Medical Care - Officer 161598 20.03.13 20.03.18 Moscow A-VI/ 4-2

Fire Fighting & Prevention 404707 29.03.13 29.03.18 Moscow A-VI / 1-2

Advanced fire fighting 183045 12.03.13 12.03.18 Moscow A-VI / 3

Survival at Sea 404707 29.03.13 29.03.18 Moscow A-VI / 1-1

Personal Safety and Social 404707 29.03.13 29.03.18 Moscow A-VI / 1

Respns.

Prof. In Survival Craft 324588 14.03.13 14.03.18 Moscow A-VI / 2-1

Personal Survival Techniques 404707 14.03.13 14.03.18 Moscow A-VI / 1-1

GMDSS 101******* 31.07.13 12.03.18 S-Petersburg A-IV / 2

Endorsment G.O.C. 101******* 31.07.13 12.03.18 S-Petersburg A-IV / 2

Ship Security Officer AA 0099320 17.05.13 17.05.18 Moscow A-VI/ 5

Radar Plotting 0165661 26.04.13 26.04.18 Moscow A - II / 1-2

Radar Simulator 0165661 26.04.13 26.04.18 Moscow A - II / 1-2

ARPA 0165661 26.04.13 26.04.18 Moscow A - II / 1-2

ISM Code Management 28.11.11 Vungtau-Vietnam A.1441 (18)

Helicopter (take- on/off) Safety book 28.11.11 Vungtau-Vietnam

ECDIS AA 0099955 08.05.13 08.05.18 Moscow B-I/12

A-II/1,A-II/2,A-II/3

All information contained in this document is property of Seaport

International Shipping., and should not be divulged in whole or part to any

Company or person, without the prior written permission of Seaport

International Shipping.

Safety Management System Manual

Seaport International Shipping Co. LLC Form 02: Application Form Of Seafarers

Revision: 04 Page: 3 of 3 Date: 10 - September - 2014

Prepared By: DPA Approved By: MD

SEA SERVICE RECORD (Last 5 employment record)

Company Name Rank Vessel Particulars Period

Name / Flag Type GRT Main Engines Generators From To Ship Co.

"Re-Mo" Master Altair/Antares-RF Tug-boat 1200 SCL 2500

07.1994 12.98 Connex Shipping Chief Off-Master Linaco/Malanga

Antigua&Barbuda Tanker 8000 B&W 5400 03.99 05.2000 Intertrade

Lines Master Lady Astrid

Panama Tanker 40000 B&W 23300 11.2000 07.2001 Vietsovpetro

Vietsovpetro RigMaster

Master MSP - 11

Chi Linh-Vietnam Seaplatform

Tanker --

88692 Drill. equipment

Turbine 27500 10.2001

08.2005 07.2005

08.2008 Vietsovpetro Master Shaomay-01/ 02 Vietnam Tug-boat 1800

SCL 4200 09.2008 01.2012 Samara Shipping

B.S.B.S.Shipp.Ltd. Master

Chief Off. Volgoneft-122

Orel - 04 Tanker

General-dry cargo-bulk 3518

3104 8NDV48AU

6NVD-48AU 05.2012

10.2013 12.2012

03.2014

ADDITIONAL INFORMATION: 10 years worked in JV Vietsovpetro at the

OIL&GAS industry in oil fields White Tiger as the Master. All Master-

Captain`s Certif-s renewing. Travel passport are valid. LAST Medical

examination at July 2014-valid one year. Finished DP base course and

training Certificate N IDP-1140/13 at S-Petersburg marine state

academy at August 2013.

Religion : Khiristian

Name of Mother : Tatiyana

Name of Father : Andrey

Blood Group : O + O - B + B -

A + A - AB + AB -

AGENT DETAILS:

SIGNATURE OF APPLICANT: _Dm . Zinkin DATE: _10

September 2014

All information contained in this document is property of Seaport

International Shipping., and should not be divulged in whole or part to any

Company or person, without the prior written permission of Seaport

International Shipping.

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