Capital Ship Management Corp.

HRM: 03-03A-03

SEAFARER’S RECORD APPLICATION FORM

Applicant’s Surname: Applicant’s First Name: Laurentiu Nicusor

Popa

Rank: Date of birth: 06.07.1986 Age: 34 Place of birth: Braila

Chief Officer
Home address:
Str. Dorobantilor Nr 48, Bl A55, Sc 3, Ap 103, Braila, Romania
Approximate Weight : 95 kg Height : 182cm
Marital Single Married X Next of kin: Popa Daniela Telephone: 0755075343
Status:
DOCUMENTS NUMBER ISSUING AUTHORITY Date Issued Expiry Date
Passport 056054078 Braila 09.07.2018 09.07.2023
Seaman’s book 24281CT ANR 22.07.2016 02.11.2022
National License/Diploma
S T C W Endorsement/COC 81250 ANR 29.05.2018 24.03.2022
Flag Endorsement 0078910 ANR 05.11.2020 24.03.2022
Medical Fitness Certificate 2156 SC. ARTEMONA MED. BRAILA 02.11.2020 02.11.2022

TRAINING CERTIFICATES YES NO ISSUING AUTHORITY Date Issued Expiry Date

LIFE-SAVING & FIRE FIGHTING VI / 1-1, 1-2, 1-3, 1-4 X CERONAV 30.09.2020 30.09.2025
PERSONAL SURVIVAL TECHNIQUES A-VI/1 X CERONAV 30.09.2020 30.09.2025
PERSONAL SAFETY AND SOCIAL RESPONSIBILITIES A-VI/1 X CERONAV 30.09.2020 30.09.2025
SURVIVAL CRAFT & RESCUE BOATS VI/ 2-1 X CERONAV 30.09.2020 30.09.2025
ADVANCED FIRE FIGHTING VI/ 3-1 X CERONAV 11.09.2020 11.09.2025
MEDICAL FIRST AID VI/ 4-1
MEDICAL CARE VI/ 4-2 X CERONAV 04.07.2016
RADAR, ARPA, BRIDGE TEAMWORK A-I/12 A-I I/2 X CERONAV 17.05.2017 17.05.2022
WATCHKEEPING II/III
GMDSS (GO) IV/2 X CERONAV 24.03.2017 24.03.2022
PREVENTION OF POLLUTION A-II/1 A-II/2
HANDLING OF DANGEROUS CARGOES A-II/1 A-II/2
MARITIME ENGLISH A-II/1 A-II/2
TANKER FAMILIARIZATION V/1, 1-7
SPECIALIZED TANKER FAMILIARIZATION V/1 8-14
SPECIALIZED CHEMICAL TANKER FAMILIARIZATION V/1 15-21
ECDIS TRAINING A-II/1 A-II/2 X CERONAV 25.10.2013
SHIP SECURITY OFFICER TRAINING X CERONAV 01.11.2013
BRIDGE/ENGINE TEAM AND RESOURCE MANAGEMENT
SHIP HANDLING AND MANEUVERING SIMULATION A-II/1 A-II/2
ICE NAVIGATION TRAINING
TANKER MANAGEMENT AND SELF-ASSESSMENT
RISK ASSESSMENT AND INCIDENT INVESTIGATION
SAFETY OFFICER TRAINING
OTHERS:

KNOWLEDGE OF ENGLISH: Good

VETTING EXPERIENCE: No

USA TRANSIT VISA Yes

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Capital Ship Management Corp. HRM: 03-03A-03

SEAFARER’S RECORD APPLICATION FORM

PREVIOUS SEA SERVICE - MINIMUM LAST FIVE YEARS

COMPANY VESSEL RANK TYPE FLAG DWT ENGINE TYPE FROM TO REASON FOR SIGNING OFF
Orion Reederei Intrepid 2 Officer
nd
Bulk Carrier Malta 52346 MAN B&W 6S50MC 17.01.2020 16.07.2020 EOC

Orion Reederei Concordia 2nd Officer Bulk Carrier Malta 82499 MAN B&W 5S60MC 09.03.2019 10.09.2019 EOC

Orion Reederei Bellatrix 2nd Officer Bulk Carrier Liberia 77053 MAN B&W 5S60MC 29.07.2018 11.11.2018 EOC

12.07.2021
Orion Reederei Hero 2nd Officer Bulk Carrier Liberia 178076 MAN B&W 6S70MC 03.02.2018 EOC
7

Orion Reederei Rugia 2nd Officer Bulk Carrier Liberia 176505 MAN B&W 6S70MC 09.09.2016 16.02.2017 EOC

Orion Reederei Intrepid 3rd Officer Bulk Carrier Malta 52346 MAN B&W 6S50MC 02.09.2015 06.02.2016 EOC

Orion Reederei Columbia 3rd Officer Bulk Carrier Liberia 52346 29.12.2014 21.05.2015 EOC

MASTER / OFFICER SUPPLEMENT

RANK 2nd Officer APPLICANT’S SIGNATURE:
TOTAL YEARS IN RANK 2 Actual sea service Popa Laurentiu
TOTAL YEARS WITH OPERATOR 5 Calendar years
TOTAL YEARS ON THIS TYPE OF TANKER (as applicable) Actual sea service
TOTAL YEARS ON ALL TYPES OF TANKERS (as applicable) Actual sea service
DATE: 09.11.2020
TOTAL YEARS ON BULK CARRIERS (as applicable) 8 Actual sea service
(use 1 decimal i.e., 2.4 yrs)

FOR CAPITAL SHIP MANAGEMENT CORP. CREW DEPT USE ONLY

PROPOSED BY MANNING OFFICE/AGENT: DATE REVIEWED & APPROVED FOR INITIAL PROCESSING:

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