High School Elementary

Form No. CRW** Rev.* ** AUG **

*nd Floor M. De Leon Building 1151 M.H. Del Pilar Ermita Manila

Tel.(02) 530-8007

DATE APPLIED: january 11 2025 IRIS No.:

#NAME?

POSITION APPLYING FOR: Bosun

AVAILABILITY: January or Feb.2025

SEAFARER APPLICATION FORM

PART I - PERSONAL DATA

LAST NAME: FIRST NAME: MIDDLE NAME: CIVIL STATUS:

Pamisan Vilmhar Jongay married

PERMANENT ADDRESS: TEL. NO. CELLPHONE NO.

093********/09664951 096********/093********

Purok 2 Basaeon street,Regador Ibajay Aklan 566

CONTACT ADDRESS: E-MAIL ADDRESS: RELIGION:

********@*****.*** bible baptist

DATE OF BIRTH: AGE: PLACE OF BIRTH: HEIGHT:WEIGHT: LANGUAGES SPOKEN: NATIVE FOREIGN

10.22.80 regador ibajay aklan 5' 5 " 118

Lbs. english,tagalog,

BLOOD TYPE: TIN No.: SSS No.: PHILHEALTH No.: PAG-IBIG No.: POEA SRC No.:

A n/a 730-***-**** 020********* 0506001-04

WIFE'S FULL MAIDEN NAME: Number of Sons / Daughters: CELLPHONE NO. / E-MAIL ADDRESS:

Lucille villanueva Solano 962-***-**** ****************@*****.***

1st CHILD GIVEN NAME: AGE: 2nd CHILD GIVEN NAME: AGE: 3rd CHILD GIVEN NAME: AGE: 4th CHILD GIVEN NAME: AGE:

Iniego Zion 11

FATHER'S FULL NAME: MOTHER'S FULL MAIDEN NAME: NEXT OF KIN: ADDRESS & CONTACT NUMBER:

Vicente Pamisan Edwina Pamisan Amafel Solano lancaster imus cavite/096********

PART II - EDUCATION

LEVEL NAME OF SCHOOL CITY / PROVINCE FROM TO

College Aklan polytechnic college Course: Bs in Marine Transfortation kalibo aklan

High School melchor memorial school Pob.ibajay aklan

Elementary regador elementary school Regador ibajay aklan

PART III - LICENSES

28-33136 DATE ISSUED: march 19 2015 VALID UNTIL: none expiry

GOC LICENSE No. DATE ISSUED: VALID UNTIL:

TESDA NCI/NCIII No. DATE ISSUED: VALID UNTIL:

PART IV - TRAVEL DOCUMENTS

DOCUMENT TYPE NUMBER DATE ISSUED VALID UNTIL DOCUMENT TYPE NUMBER DATE ISSUED VALID UNTIL

passport P5967982B 16-Dec-30 AUSTRALIAN MCV

SEAMAN BOOK C0997022 sept.30 2016 sept 28 2026 YELLOW FEVER VACC. QR D32965 1-Mar-07

U.S.A. VISA 202*********** 24-Jun-21 17-Jun-26 CHOLERA VACC.

PART V - FOREIGN FLAGSHIP DOCUMENTS

DOCUMENT TYPE NUMBER DATE ISSUED VALID UNTIL DOCUMENT TYPE NUMBER DATE ISSUED VALID UNTIL

Panama SIRB Marshall Island End.

Panama GOC Marshall Island Book

Liberia End. Bahamas Endorsement

Liberia Book Bahamas Book

Cyprus End. Malta Endorsement

Cyprus Book Malta Book

PART VI - TRAINING CERTIFICATES

COP CERTIFICATES NUMBER DATE ISSUED TRAINING CENTER CERTIFICATES NUMBER DATE ISSUED

Basic Training bt200011298219 sept.12 2019 Engine Room Simulator

Prof. In Survival Craft & Rescue Boat pscrb200029977621 aug.12 2021 Auxiliary Machinery System

Advanced Fire Fighting Control Engineering

Medical Emergency First Aid Hydraulics and Pneumatics

Medical Care Dangerous & Hazardous Materials

Ship Security Officer MARPOL (CONSOLIDATED)

BTOC TESDA (NC1)

ATCT TESDA (NC3)

ATOT Deck / Engine Watchkeeping

Fast Rescue Boat (FRB) Welding Course EAW-0455-11 july 29 2011

SDSD Lathe Machine Course

TRAINING CENTER CERTIFICATES NUMBER DATE ISSUED Practical Assessment

Safety Officer Course Culinary / Catering Course

Risk Assessment Messman Course

Incident Investigation CROWD AND CRISIS MGT.

ECDIS GENERIC Shore-based Fire Fighting

ECDIS SPECIFIC Crude Oil Washing

Bridge Resourse/Team Mgmnt. Inert Gas System

SSBT FRAMO Course

Ship Handling Course Free-Fall Lifeboat Familiarization

INMARSAT/SATCOM Environmental Management

GMDSS Human Relationship

ROC/ROP Bilge Water Waste Management

ARPA Tank Atmospher & Gas Measurement

RSC Automatic identification System

SRROC BTLGT

PART VII - DETAILS OF SEA-GOING EXPERIENCE (Starting with the LATEST in chronoligical order)

MAIN ENGINE PERIOD(dd-mm-yr)

Year Built

Vessel Name Vessel Type Flag GRT DWT Maker Type or Model BHP Rank Sign-on Sign-off Months Trade Route Reason for sign-off Manning Agency Principal's Co. Name

Vessel Name Vessel Type Flag GRT Column1 Year Built Maker Type BHP Rank Sign-on Sign-off Months Trade Route Reason for sign-off Manning Agency Principal's Co. Name

contantinos p II containership Marshall 93000 2013 Bosun june 2 2021 May 29 2022 11 worldwide extended marlow navigation

Anthea Y containership marshall 93000 2014 Bosun sept 16 2019 sept.18 2020 12 worldwide extented marlow navigation

Yasa Emerhan Bulkcarrier turkish 46000 2009 Bosun july 3 2018 may 29 2019 10 worldwide extended marlow navigation

skogafoss container/heavylift antigua barboda 10000 2002 Bosun nov 21 2016 oct.19 2017 11 worldwide extended marlow navugation

Delphinus containership antigua barboda 9000 2000 Bosun june 25 2015 july 6 2016 13 worldwide extended marlow navigation

Essen Express containership hapaglloyd/german 142***-**** Bosun jan. 13 2014 Nov 11 2013 10 worldwide extended marlow navugation

willington express container german 16000 2006 Ab 0 worldwide marlownavigation

prague express container german 93000 2011 os 0 worldwide marlow navigation

frankfurt express container german 92000 2011 os 0 worldwide marlow navigation

PART VIII - CONTACT DETAILS OF AT LEAST 3 FOREIGN PRINCIPALS

COMPANY NAME OFFICE ADDRESS CONTACT NUMBERS E-MAIL ADDRESSES / FAX NUMBER PERSON-IN-CHARGE

marlow navigation marlow building leon guinto st.cor san antonio malate manila 917-***-**** Benjie

marlow navigation marlow building leon guinto st.cor san antonio malate manila 917-***-**** Christine

PART IX - DETAILS OF WORK EXPERIENCE ASHORE, IF ANY

COMPANY NAME & ADDRESS POSITION FROM TO JOB DESCRIPTION REASON FOR LEAVIING

PART X - MEDICAL BACKGROUND

YES NO

Please type "X" (IF YES, PLEASE DESCRIBE)

Any Previous Surgery? x

Any Previous Serious Illness / Injury / temporary disability? x

Any Physical Handicap? x

Any Drug Related Problem? x

Any Alcohol Related Problem? x

NOTE: In case and in the event that I withdraw my documents after approval by the

Any involvement in an accident resulting to loss of life or x principal, I hereby agree to pay and reimburse all the expenses for processing fees and cost

personal injury or damage to ship, cargo, pollution, etc.? (POEA Contract, PEME, Visa, Flags, Trainings and other Certificates) Unless the withdrawal is

PART XI - CHARACTER REFERENCES due to the fault of the principal or the company. Document release shall be affected within

NAME / POSITION COMPANY NAME / ADDRESS CONTACT NUMBERS / E-MAIL five (5) working days after the request is made, provided further that all fees and cost have

been paid.

crewing manager mam Christine marlow navigation 917-***-****

crewing manager sir Benjie marlow navigatiom 917-***-****

I HEREBY, certify that I have not been involved, charged or convicted in any administrative civil and/or criminal or tribunal in any jurisdiction either local or international in connection with my employment as a seafarer onboard ocean going vessel.

I futher certify that I have not been involved, charged or convicted in any administrative, civil or criminal court or tribunal for cases associated with magic pipes and other similar activities in any U.S. Jurisdiction neither was I been deported or placed under blacklist

by the U.S. Coast Guard and or the U.S. Environmental Protection Agency as consequence thereof.

I HEREBY CERTIFY that the information above is true and correct. Any misrepresentation or misinformation on my part shall be grounds for the revocation of my application and if already employed, shall be ground for termination without any responsibility / liability on the part of Global Gateway

Crewing Services, Inc. whatsoever.

vilmhar pamisan Date: january 13 2025

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