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    F06.18 GENERAL STATEMENT OF HEALTH 25 MARCH 2020 Compl

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    Валентин Смирнов
    Valentyn Smirnov, a crew member from Ukraine, signed a general statement of health on September 23, 2020 in Odessa, Ukraine declaring that he is healthy, has taken necessary precautions to avoid COVID-19 exposure, and does not show any COVID-19 symptoms based on a medical screening. The statement includes his name, date of birth, passport information, and country of birth.

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    F06.18 GENERAL STATEMENT OF HEALTH 25 MARCH 2020 Compl

    Uploaded by

    Валентин Смирнов
    14 views2 pages
    Valentyn Smirnov, a crew member from Ukraine, signed a general statement of health on September 23, 2020 in Odessa, Ukraine declaring that he is healthy, has taken necessary precautions to avoid COVID-19 exposure, and does not show any COVID-19 symptoms based on a medical screening. The statement includes his name, date of birth, passport information, and country of birth.

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    F06.18 GENERAL STATEMENT OF HEALTH 25 MARCH 2020 compl

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    Valentyn Smirnov, a crew member from Ukraine, signed a general statement of health on September 23, 2020 in Odessa, Ukraine declaring that he is healthy, has taken necessary precautions to avoid COVID-19 exposure, and does not show any COVID-19 symptoms based on a medical screening. The statement includes his name, date of birth, passport information, and country of birth.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    14 views2 pages

    F06.18 GENERAL STATEMENT OF HEALTH 25 MARCH 2020 Compl

    Uploaded by

    Валентин Смирнов
    Valentyn Smirnov, a crew member from Ukraine, signed a general statement of health on September 23, 2020 in Odessa, Ukraine declaring that he is healthy, has taken necessary precautions to avoid COVID-19 exposure, and does not show any COVID-19 symptoms based on a medical screening. The statement includes his name, date of birth, passport information, and country of birth.

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    © All Rights Reserved
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    of 2

    AMANCIO SHIPPING CORP. Edition: 01 Rev.

    : 00 Valid since: March 2020

    COVID19 ORIGINAL KEPT ON BOARD / COPY TO THE OFFICE Page 1 of 1


    F06-18 General Statement of Health

    GENERAL STATEMENT OF HEALTH

    DATE: 23.09.2020

    PLACE: Odessa, Ukraine

    I Valentyn Smirnov, date of birth 19/10/1995, passport number FB020990, country of birth Ukraine,

    declare that I am healthy and all information provided on the Additional Gangway Medical Screening

    (F0614) are true. To the best of my knowledge I have taken all necessary precautions to prevent myself

    from been exposed to COVID-19 and up till date do not show to have any symptoms associated to COVID-

    19.
    Name & Signature Valentyn Smirnov

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