#N/A River crew Applicant's info

Matrose
Application for the position: Steuermann Applicant for the vessel: Rumanian

Family name: Date of birth: Slowak Age:

Given name: Place of birth: Polish
Other name(s): Nationality:
Address: Street: Marital status: Child 1:
Apartment: Child 2:
City: Child 3:
Postal Code: Child 4:
Country:
Nearest airport: Telephone no 1: Tel no 2:
E-mail address: Mobile phone 1: Mobile 2:

Beneficiary (insurance) Bank account no. (IBAN):

Relationship to crew:
Benef. Address 1: Bank name:
Benef. Address 2: Bank branch name:
Benef City: Bank City: Country:
Benef Country: Swift code:
Benef Telephone:
Please complete (at least) the YELLOW fields
Benef Email:
Single
Seaman's / River Book no.: Issued where: Seaman's Book issue date: Valid until:
Passport or ID Card number: Issuing authority: Passport / ID issue date: Valid until:
Position in River Book:

STCW Courses Number Date completed

Basic Safety Training: Date last medical exam: Rnw MedExm!
Tanker Training: Clinic/Doctor:

Typhoid vaccination: Issue date: Valid until:

Please submit copies or scans of all valid documents!
 , , , years old Applicant's info

Prop Power Salary (EUR)

From Until Months Name Vessel Position Vessel Type Flag Tonnage #N/A Agency / Owner Country
in kW Indication