PERSONAL INFORMATION

*. Surname: CHERMAN *. Name & Father’s Name: VASILII ANATO

3. Date & Place of birth: 07.10.1976 / MARIUPOL 4. Citizenship: RUSSIAN

5. Passport (international) FA 639017 issued 24.07.2015 valid 24.07.2025

6. National Seaman Book AB 602545 issued 21.12.2017 valid 21.12.2022

7. Гражданский паспорт 09 14 489040кем и когда выдан УМВД России по г.Cевастополю

8. Permanent Address:Kombriga Potapova str.,24 app.35 Sevastopol, Crimea Region

9. Phone(s) +797********-**. Marital status MARRIED

11. Children under 16: One 12. Next of Kin & relationship Cherman Yuliya / Wife

12. Address of Next of Kin: Kombriga Potapova str., 24 app.35 13.E-Mail: adpwfi@r.postjobfree.com

14. US Visa L5054903 issued 12.05.2016 valid 10.05.2026

15. Readiness 18.05.2021

RANK & CERTIFICATES

1.Rank Master

2.License Deep sea captain number ASF 204882401 issued 18.05.2021 valid by Endorsement

3.Endorsement Master number ASF204882401 issued 18.05.2021 valid 10.11.2025

4.School(s) attended Odessa national maritime academy from 01.09.1996 to 03.03.2003 type of diploma

5.Engineer-navigator

6.Certificates

STCW-95 Courses attended

Number

Date issue

Date valid

BASIC SAFETY TRAINING AND INSTRUCTION

1607293

10.11.2020

10.11.2025

SHIP’S MEDICAL CARE

001348

23.11.2020

23.11.2025

MEDICAL FIRST AID

1572594

17.11.2020

17.11.2025

ADVANCED FIRE FIGHTING

15711119

12.11.2020

12.11.2025

PROFICIENCY IN SURVIVAL CRAFT & RESCUE BOAT

1608946

11.08.2020

11.08.2025

PROFICIENCY IN FAST RESCUE BOATS

003547

23.04.2021

23.04.2026

DANGEROUS CARGO

7759

06.11.2017

06.11.2022

RADAR NAVIGATION

1620070

01.12.2020

01.12.2025

ARPA

1621529

04.12.2020

04.12.2025

G.M.D.S.S.

ASF 204882391

18.05.2021

10.11.2025

SHIP SECURITY OFFICER

ASF204882388

18.05.2021

27.11.2025

SHIP SAFETY OFFICER

11.08.2014

11.08.2019

ISM CODE

0040/2017

22.12.2017

22.12.2022

H2S BASIC TRAINING

0160/2017

21.12.2017

21.12.2022

ECDIS

1623028

11.12.2020

11.12.2025

BRIDGE TEAM MANAGEMENT

000943

16.04.2021

16.04.2026

FOREIGN LANGUAGES

Language

Knowledge

Independent test results (FOR OFFICE USE ONLY)

ENGLISH

Good

PHYSYCAL DECLARATION

1.Height 183 cm Date of last medical examination 22.04.2021

2.Weight 89 kgs Drugs & Alcohol test date 22.04.2021

3.Boiler Suits Size 54 Yellow Fever valid 04.08.2021

4. Safety Shoes Size 44

PREVIOUS SEA SERVICE

(The most recent first)

Vessel’s name

Company/Flag

Type of vessel

GRT

Type of Engine

Engine Mod.

B.H.P.

Rank

From

DD/MM/YY

To

DD/MM/YY

ALMASEH ALBAHRI SULTAN

ADAMS / Saudi Arabia

HSV

501

Master

15.08.2020

ON BOARD

ALLIANZ TITANIUM

Allianz Middle East / Marshal Island

AHTS

1986

Master

18.10.2020

06.04.2021

AMIL-17

Allianz Middle East / Pallau

AHTS

1641

Master

05.01.2020

16.05.2020

AMIL-17

Allianz Middle East / Pallau

AHTS

1641

Master

15.07.2019

25.11.2019

AOS VENTURE

AMG / Panama

Utiity Vessel

1182

Master

23.12.2018

11.04.2019

HAILEY PRINCESS

Limin Marine / Indonesia

AHTS

1678

Master

01.07.2018

10.09.2018

HAILEY PRINCESS

Limin Marine / Indonesia

AHTS

1678

Master

15.02.2018

01.04.2018

GARUDA OFFSHORE

Armada Samudra / Indonesia

AHTS

901

Master

05.09.2017

03.11.2017

CHRISTOS XLVI

Spanopoulos Group / Greece

AHTS

799

Master

10.05.2017

28.07.2017

ERAMERAH PUTIH

Era Endoasia / Endonesia

AHTS

1441

Master

01.02.2017

12.03.2017

FOS GEMINI

Fast Offshore Indonesia / Indonesia

Fast Work Boat

785

Master

14.11.2016

07.01.2017

CM RESCUE

Caspian Mainport / Turkmenistan

AHTS

1061

Master

04.07.2016

20.10.2016

CM RESCUE

Caspian Mainport / Turkmenistan

AHTS

1061

Master

21.01.2016

31.03.2016

CAPE HATTERAS

Python Engineering /Nigeria

OSV

944

Master

12.09.2015

16.12.2015

BAYAN

Kazgac Marine / Turkmenistan

AHTS

1299

Master

27.02.2015

03.05.2015

BAYAN

Kazgac Marine / Turkmenistan

AHTS

1299

Master

23.09.2014

16.12.2014

BAYAN

Kazgac Marine / Turkmenistan

AHTS

1299

Master

07.05.2014

05.08.2014

DATE OF REGISTRATION 11.10.2021

I, Cherman Vasyl, WITH BELOW MENTIONED MY SIGNATURE ASSURE YOU THAT ALL THE ABOVE-MENTIONED INFORMATION IS CORRECT AND I WILL BEAR RESPONSIBILITY FOR ANY MISTAKES MADE BY ME BY ANY REASONS.

SIGNATURE OF APPLICANT

APPLICATION FORM

Набран в:

Базе SMM

AET

AEBLO

Preliminary

MSC

Ishima

Отсканирован

Легитимность набрана

FOR ENGINEERS ONLY

FOR OFFICE USE ONLY

OFFICER IN CHARGE

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