Captain of cargo vessel or jobs within maritime industry

APPLICATION FORM

GENERAL INFORMATION

Position - Master Available from - TBN

Family name - Pechnikov First name - Vladyslav Father's name - Anatoliovych

Date and Country of birth - 16.07.1968, Ukraine Nationality - Ukraine

Home address - Odessa, Ukraine

Phones - +380-**-******* Mob. - +380-**-******* E-Mail - ********@****.**

English language knowledge Excellent Good Satisfactory Poor

X

Marital status - Married Children (name/D.O.B.) - Oleksiy -

12.08.1996,

Alona - 07.07.2004

Next of kin (full name/relation) - Svitlana Pechnikova, wife

Education - Odessa State Maritime Academy US Visa exp.

28.05.2018

RECORDS OF SEA SERVICE

Ship's name

(year built)

Name of ship Crewing Agency / Telephone numbers / Person in charge

Shipowner Address

HHL Congo / HHL Marlow Navigation / www.marlow.com / Maria Michael /

Rhine Hansa heavy Lift www.hansaheavylift.com Frank Roeskens

Suederoog Leda Shipping / www.ledaship.de / Helene de Wal /

Briese www.briese.de Sylvia Weiss

HHL Richards Bay Marlow Navigation / www.marlow.od.ua / Igor Ievsieiev /

Hansa heavy Lift www.hansaheavylift.com Marina

Tolmachova

Cape Race DS Schiffahrt www.ds-schiffahrt.de Frank-Uwe

Schneider / Olga

Skenova

Beluga Sao Paulo Marlow Navigation / www.marlow.od.ua Mike Naradko /

Beluga Group www.beluga-group.com Thomas Awiszus

Beluga Recognition Marlow Navigation / www.marlow.od.ua Mike Naradko /

Beluga Group www.beluga-group.com Thomas Awiszus

Beluga Resolution Marlow Navigation / www.marlow.od.ua Mike Naradko /

Beluga Group www.beluga-group.com Thomas Awiszus

Beluga Skysails Marlow Navigation / www.marlow.od.ua Mike Naradko /

Beluga Group www.beluga-group.com Thomas Awiszus

Beluga Eternity Marlow Navigation / www.marlow.od.ua Mike Naradko /

Beluga Group www.beluga-group.com Thomas Awiszus

Beluga Emotion Marlow Navigation / www.marlow.od.ua Mike Naradko /

Beluga Group www.beluga-group.com Thomas Awiszus

NATIONAL PASSPORTS DETAILS

National Passport # ?436689 Issued 24.10.1996 Exp NA

Issued by Malinovskiy RO UMVD Odessa, Ukraine

International Passport (OVIR) # ET844978 Issued 03.04.2012 Exp 03.04.2022

Seaman's Passport # AB527170 Issued 18.04.2014 Exp 18.04.2019

NATIONAL DOCUMENTS AND CERTIFICATES

Competency Grade Deep Sea # 03493/2003/08 Issued 09.09.2003

Captain

Endorsement of Competency # 03493/2003/08 Issued 28.12.2012 Exp 31.12.2016

STCW`78/95 - A-VI/1 (Basic # 13423 Issued 16.11.2012 Exp 16.11.2017

Safety)

(personal survival, fire prevention, elementary first aid & social responsibilities)

Proficiency in survival craft # 09446 Issued 16.11.2012 Exp 16.11.2017

Advanced fire fighting # 05363 Issued 16.11.2012 Exp 16.11.2017

Ship's medical care # 00542 Issued 16.11.2012 Exp 16.11.2017

Radar Observation & Plotting + # 00130 Issued 16.11.2012 Exp 16.11.2017

ARPA

ECDIS operator # 01518 Issued 04.05.2012 Exp 04.05.2017

GMDSS Operator # 01666/2003/08 Issued 26.08.2003

Endorsement of GMDSS # 01666/2003/08 Issued 02.01.2013 Exp 31.12.2016

Hazardous Cargo # 04729 Issued 19.11.2012 Exp 19.11.2017

Ship's Security Officer # 00720/2013/04 Issued 05.12.2013 Exp 05.12.2018

Bridge Team Management # Schenefeld Issued 01.10.2009 Exp

Ship Handling Arrangements # 00097 Issued 26.11.2012 Exp 26.11.2017

US Visa Issued Exp

OTHER DOCUMENTS AND CERTIFICATES

Ballast Water and Sediment # 693/06 Issued 07.09.2006 Exp NA

Manag.

Safety Awareness training # 711/10 Issued 13.09.2010 Exp

program

Anti-Piracy preparedness and # Issued 07.12.2009 Exp

resp.

Medical Examination # Issued Exp

Yellow Fewer # Issued 13.01.2009 Exp 13.01.2019

FLAG STATE DOCUMENTS

Document Country Number Issued Expired

Seaman's Book Antigua # 120027 30.04.2012 29.04.2017

Seaman's Book Liberia # 1014086 25.10.2011 25.10.2016

Endorsement Gibraltar # 06175/13 18.01.2013 31.12.2016

NOTES (for office use only)

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