F.**, ed.*, rev.*, Page * of *

SEAFARER'S APPLICATION FORM - PERSONAL

PERSONAL INFORMATION

Family Name MUNTEAN First Name (s) VICTOR

Birth Date 15/09/1990 Birth Place CHISINAU

Father’s Name VITALIE Mother’s Name ELENA

Nationality ROMANIAN Religion CHRISTIAN

Marital Status SINGLE No. of Children NIL

Height (cm) 172 Weight (kg) 82

Shoes Size 42-43 Overall L

Eye Color BROWN Hair Color BROWN

Nearest Airport BUCHAREST

ADDRESS (include telephone country & area codes, advise also secondary or contact addresses) Street &Nr. BD. IC BRATIANU 64, b1 sc A

ap 13

Email Address VICTOR_MUNTEAN_1990@YAH

Location CONSTANTA, ROMANIA Mobile Phone OO.+407******** COM City CONSTANTA Residence Phone NIL

State, Country ROMANIA Skype/Facebook VICTOR_MUNTEAN_1990 Postal (ZIP) Code P.O. Box (if any)

NEXT OF KIN INFORMATION (person to contact in case of emergency & insurance beneficiary) Family Name MUNTEAN First Name(s) MARIA

Nationality ROMANIAN Relationship SISTER

Street &Number AL CEL BUN 108 Email Address

Location CHISNAU Mobile Phone 003**********

City CHISINAU Residence Phone 003**********

State, Country REPUBLIC OF MOLDOVA Skype/Facebook

Postal (ZIP) Code MD-2005 P.O. Box (if any)

REMARKS:

Requested Rank DECK CADET, OOW, Availability Date 01.02.2020 Prefer. Vessel Type ANY Minimum Salary ***

English Language Skills Spoken: fluent /v. good / - Written: fluent / v. good / Other Foreign Languages FRENCH, RUSSIAN, GERMAN

Professional School / Academy -

Name & Period (From - To)

MERCHANT MARITIME UNIVERSITY OF CONSTANTA

2010-2014

Foreign Crew Experience

(specify nationalities)

BAHAMAS, FRENCH, CYPRUS

Other Skills

Further Remarks

I hereby affirm that all the information provided by me in this application is true and correct to the best of my knowledge. Date:

26.08.2019

Signature:

Family

Name

MUNTEAN First

Name(s)

VICTOR Rank DECK CADET, OOW, AB

A. TRAVEL DOCUMENTS AND MEDICAL CERTIFICATES

F.28, ed.2, rev.0, Page 2of 3

Document Name (Description) Document

Number

Country Issue Place Issue Date Exp. Date

Passport 055371324 ROMANIA CONSTANTA 22.12.2017 22.12.2022 Seaman's Book (national) 31692CT ROMANIA CONSTANTA 13.06.2018 09.10.2021 Seaman's Book (flag state)

Seaman's Book (flag state)

Visa - United States (type C1/D) K1461797 ROMANIA BUCHAREST 21NOV2014 19NOV2019 Visa - Others (Work/ Resid. Permits)

Medical Examination Report 4624 ROMANIA CONSTANTA 09.10.2019 09.10.2021 Drug & Alcohol Test

Vaccination against Yellow Fever N/A REP OF

MOLDOVA

CHISINAU 22.08.2013 LIFETIME

Vaccination against Cholera

B. CERTIFICATES OF COMPETENCY & ENDORSEMENTS, COURSE CERTIFICATES Document Name (Description) Document

Number

Country Issue Place Issue Date Exp. Date

Certificate of Competency 77721 ROMANIA CONSTANTA 09.06.2019 Endorsement 77721 ROMANIA CONSTANTA 09.06.2019

Basic Safety Training 00009944 ROMANIA CONSTANTA 01.04.2016 01.04.2021 Proficiency in Survival Craft and

Rescue Boats, other than Fast Rescue

Boats

00012696 ROMANIA CONSTANTA 30.03.2017 30.03.2022

Designated Security Duties 00004223 ROMANIA CONSTANTA 11.03.2013 LIFETIME Medical First Aid/ Medical Care 00005911 ROMANIA CONSTANTA 16.02.2017 LIFETIME Advanced Fire-Fighting 000010752 ROMANIA CONSTANTA 21.03.2017 21.03.2022 Maritime English N/A

Risk Assessment in Ship Operation

Prevention of the Marine Pollution of

the Marine Environment

Transport and Handling of

Dangerous Goods

HELM 00002856 ROMANIA CONSTANTA 24.02.2017 LIFETIME Passenger Specialization 00001668 ROMANIA CONSTANTA 03.03.2016 03.03.2021 Basic Training for Oil and Chemical

Tanker Cargo Operations

Advanced Training for Chemical

Tanker Cargo Operations

Advanced Training for Oil Tanker

Cargo Operations

Basic Training for LPG Tankers

Cargo Operations

Advanced Training for LPG Cargo

Operations

Date:15.01.2020 Signature:

F.28, ed.2, rev.0, Page 3of 3

Family Name: MUNTEAN First Name(s): VICTOR Date of Birth:15.09.2019 Vessel's Name

IMO Flag DWT kW Vessel

Type

EngineType Rank S/On Date S/Off Date Sign off

Reason

Recruiting Agency Ship Owner

(company to contact for

reference)

AKNOUL 8917883 BAHAM

AS

6809G

RT

5916 RO/RO DECK

CADET

14.03.2015 19.07.2015 EOC CMA SHIPS

CMA CGM

NORMA

9299812 FRENCH 107711

UUMS

68640 CON DECK

CADET

26.08.2015 15.01.2016 EOC CMA SHIPS

CMA CGM

RIGOLETTO

9299654 FRENCH 107***-***** CON DECK

CADET

30.09.2016 13.01.2017 EOC CMA SHIPS

F/B PRINCE 7347548 CYPRUS 13336 2*7943.4 RO /

PAX

WARTSILA DECK

OFFICER

04.02.2019 09.05.2019 EOC EUROPEAN

SEAWAYS INC.

F/B PRINCE 7347548 CYPRUS 13336 2*7943.4 RO /

PAX

WARTSILA DECK

OFFICE

02.07.2019 06.10.2019 EOC EUROPEAN

SEAWAYS INC.

Date:15.01.2020

Signature:

Contact this candidate