APPLICATION FORM / PERSONAL DATA

Surname: safari roudpishi

Name: saeid

Date of

Birth: 16/08/1986

City & Country: rasht/iran

Nationality: iran

Permanent address: yas flat ehsandoost alley bistoon ave rasht iran

Phone(home):009*********

Height: 181

Color of eyes: brown

Mob. Phone:009***********

Weight: 83

Color of hair:brown

e-mail:acv8tk@r.postjobfree.com

Civil Status

single

Address next of kin:

Next of kin: -

Nearest airport:tehran

POSITION: general rating(o.s)

DOCUMENTS

NUMBER

ISSUED

VALID

COUNTRY, CITY

NATIONAL PASSPORT

L27900249

19/11/2013

19/11/2018

Iran/rasht

NATIONAL SEAMAN’ S BOOK

0418002

11/04/2015

11/04/2020

Iran/anzali

LICENSE Diplome (GRADE)

5/11/13/000772

19/03/2015

19/03/2020

Iran/anzali

PASSPORT

ENGINE-ROOM RESOURSE MANAGEMENT (MANAGEMENT-LEVEL)

PROF. IN SURVIVAL CRAFT

ADVANCED FIRE FIGHTING

MEDICAL FIRST AID

MEDICAL CARE

05/15/11/1755

18/07/2016

18/07/2018

Iran/anzali

YELLOW FEVER VACCINATION

USA VISA

no

Basic Safety Training

5/014/05/000607

19/03/2015

19/03/2020

Iran/anzali

Ship Security

5/014/32/001557

03/05/2015

unlimited

Iran/anzali

Hazardous Cargoes

SEA SERVICE:

FOUR TOP OFFICERS LAST 10 YEARS, junior officers and ratings last 5 years

TYPE OF

VESSEL

NAME OF

VESSEL

GRT

HP

NAME OF

COMPANY

RANK

PERIOD OF SERVICE

FROM / TO

dd/mm/yy / dd/mm/yy

General Cargo

soren

3185

2x883kw

Parsian golden shipping

o.s

18/11/2015

11/07/2016

ENGLISH:

GOOD

SATISFACTORY

MODERATE

POOR

SIGNATURE: DATA:

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