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:******.*******@*****.***
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: