NCC Marine

Application Form

Personal Details:
Name: karim Middle Name: mahmoud
Date Of Birth: 7\7\1997 Nationality: egyptain
Height: 180 Weight: 100
Contact Details: (Please include country & area code)
Home No: +2035548824
Mobile No: +201062800143
Home Address: 42 elsag Mohamed abd salam street sidibsher. ALEXANDRIA.EGYP
Email Address: karimkoptan1@gmail.com
Skype Account: karimkoptan1@gmail.com
Nearest Airport: Alexandria Airport, Borg El Arab Airport (HBE) in Alexandria
Next of Kin Details:
Name: fatma ail
Date Of Birth: 12\5\1972 Relation:
Address: 42 elsag Mohamed abd salam street sidibsher. ALEXANDRIA.EGYP
Mobile No: +201007842175 Email Address:
Main Documents:
Document: Document No: Issue Date: Expiry Date:
Identification Card: 29707071202556 12\2021 12\2027
Passport: A18675434 1\12\2021 1\12\2026
Seaman Book: S00019562 30\11\2021 30\7\2025
Languages:
English: Poor □ Fair □ Good □
Others ( French ) Poor □ Fair □ Good □
Others ( arabic ) Poor □ Fair □ Good □
Bachelor degree: from Arab Academy for science technology and Maritime transport-Alexandria : in po
Date: 01\1\2021 Grade (GPA):
Certificate of Competency: (2nd Mate)
Issuing Authority: Certificate No: Issue Date: Expiry Date:
National:Egypt 12294 30\11\2021 30\7\2025
Malta:
Panama:
Cyprus:

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 Others ( ):
Specify Class: (Deck/Engine)
Deck Class: Master FG □ 1st Mate □ 2nd Mate □
Engine Class: 1st Class (M),(S),(M+S) □ 2nd Class (M),(S),(M+S) □ 3rd Class (ETO) □
Visas:
Visa Type: Visa No: Issue Date: Expiry Date:
US C1/D Visa
Schengen Visa
Australia MCV Visa
STCW Certificates:
Certificates/Courses: Certificate No: Issue Date:
Personal Survival Techniques 1116\21\EG 26\4\2021
Elementary First Aid
Medical First Aid 1117\21\EG 26\4\2021
Medical Care
Proficiency in Survival Crafts & Rescue Boats
Proficiency in Survival Crafts & Fast Rescue Boats 16285\21\EG 11\5\2021
Personal Safety & Social Responsibilities 1122\21\EG 26\4\2021
Basic Fire Fighting
Advanced Fire Fighting 1118\21\EG 26\4\2025
ARPA 16285\21\EG 11\5\2026
Radar Observer 1123\21\EG 26\4\2021
Radar Simulator
Ship Security Officer
Safety Security Certificate 16285\21\EG 11\5\2030
Security Training For Seafarers With Designated Security Duties 2302\21\EG 1\12\2018
Security Awareness
General Operator certificate (GMDSS-STCW) 2354\21\EG 20\12\2021
General Operator certificate (GOC)
Ship Simulator
Bridge Team Management 165\21\EG 9\12\2021
Engine Team Management
ECDIS Generic 1120\21\EG 26\4\2021
ECDIS Specific
International Medical Examination 06653 30\11\2021
Yellow Fever Vaccination 6539 11\5\2041
Able Seafarer on Engine Watch on Seasoning vessels
Certificate of Life Boat Man
Able Seafarer Deck
RO-RO Passenger Certificates:
Certificates/Courses: Certificate No: Issue Date:
Training in Crowd Management

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Safety Training For Personnel Providing Direct Services To Passengers
Crisis Management & Human Behaviour
Passenger Safety, Cargo Safety & Hull Integrity
Dangerous Cargo Certificates:
Certificates/Courses: Certificate No: Issue Date:
Dangerous Goods
Hazmat (CFR 49)
Tanker Certificates:
Certificates/Courses: Certificate No: Issue Date:
Basic Training For Officers on (Oil-Chemical) Tanker
Advanced Training Oil Tanker
Advanced Training Chemical Tanker
Basic Training For Ratings on (Oil-Chemical) Tanker
Basic Training For Officers on Liquefied Gas Tanker 1245\21 20\12\2021
Basic Training For Ratings on Liquefied Gas Tanker
Advanced Training For Liquefied Gas Tanker
Inert Gas System (IGS)
Crude Oil Washing
Cook/Steward Certificates:
Certificates/Courses: Certificate No: Issue Date:
Personal Hygiene & Environmental Protection
Safety & Health in The Provision Of Meals
Food Storage & Inventory Control
Practical Ability To Prepare Meals & Food
Other Certificates You May Hold:
Certificates/Courses: Certificate No: Issue Date:
prevention combating of marine pollution 1167\21 26\4\2021
10. communication course 1119\21\EG 26\4\2021
marlin test record 77 E422A93AE9DDFC14 20\12\2021

Medical History/Health:
Is there anything concerning your medical history or state of health that is relevant to your application? E.g.
Recent operations/illnesses
If yes, please explain:
Have you ever signed off a vessel due to any medical reason?
If yes, please explain:
Applicant Consent:
By clicking the "Agree" box, you give your consent to NCC Marine to act on your behalf and share your
personal & professional details with possible employers in an effort to assist you in gaining an employment
on board a vessel of their fleet. This agreement can be revoked at anytime provided that you submit a
request in writing informing us that you wish to revoke your consent.

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By clicking the "Agree" box, you give your consent to NCC Marine to act on your behalf and share your
personal & professional details with possible employers in an effort to assist you in gaining an employment
on board a vessel of their fleet. This agreement can be revoked at anytime provided that you submit a
request in writing informing us that you wish to revoke your consent.

4th E

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 REC01

m Insert Photo

Surname: mahmoud
Rank/Position: second officer
Shoe Size: 45
& area code)
24
143
dibsher. ALEXANDRIA.EGYPT
mail.com
mail.com
rport (HBE) in Alexandria

mom
dibsher. ALEXANDRIA.EGYPT

Expiry Date: Issuance Place:

12\2027 alexandria
1\12\2026 alexandria
30\7\2025 alexandria

Good □ Very Good □ Fluent

Good □ Very Good □ Fluent □
Good □ Very Good □ Fluent □
rt-Alexandria : in port management and fleet operation
Grade (GPA): 2.7
Mate)
Expiry Date: Issuance Place:
30\7\2025
The Egyptian Authority for the Safety of Maritime Navigation

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)
2nd Mate □ Other ( ) □
3rd Class (ETO) □ Other ( ) □

Expiry Date: Issuance Place:

Issue Date: Expiry Date: Issuance Place:

26\4\2021 3\7\2025 Arab Academy for science technology and Maritime transport-Alexandria

26\4\2021 Arab Academy

3\7\2025
for science technology and Maritime transport-Alexandria

11\5\2021 Arab Academy

10\5\2026
for science technology and Maritime transport-Alexandria
26\4\2021 Arab Academy
3\7\2025
for science technology and Maritime transport-Alexandria
Arab Academy for science technology and Maritime transport-Alexandria
26\4\2025 Arab Academy
3\7\2025
for science technology and Maritime transport-Alexandria
11\5\2026 Arab Academy
10\5\2031
for science technology and Maritime transport-Alexandria
26\4\2021 Arab Academy
for ever
for science technology and Maritime transport-Alexandria

11\5\2030 Arab Academy

10\5\2035
for science technology and Maritime transport-Alexandria
1\12\2018 Arab Academy
26\4\2023
for science technology and Maritime transport-Alexandria

20\12\2021 Arab Academy

10\5\2026
for science technology and Maritime transport-Alexandria

9\12\2021 8\12\2026 pan arab

26\4\2021 Arab Academy

For ever
for science technology and Maritime transport-Alexandria
Arab Academy for science technology and Maritime transport-Alexandria
30\11\2021 Preventive
Forever
sector General Administration of Quarantine Egypt
11\5\2041 Preventive
10\5\2046
sector General Administration of Quarantine Egypt

es:
Issue Date: Expiry Date: Issuance Place:

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es:
Issue Date: Expiry Date: Issuance Place:

Issue Date: Expiry Date: Issuance Place:

20\12\2021 2o\12\2026

:
Issue Date: Expiry Date: Issuance Place:

old:
Issue Date: Expiry Date: Issuance Place:
26\4\2021 For ever
26\4\2021 For ever
20\12\2021 19\12\2022

ur application? E.g. Yes □ No □

Yes □ No □

nd share your
g an employment
you submit a Agree □ Disagree □

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 Agree □ Disagree □

4th Edition, February 2021 | Crewing Section

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 NCC Marine

Sea-Service Experience (Rec

From To Rank Vessel Name Vessel Type

24\11\2018 10\12\2019 cadet wadi elyarmouk bulk carrier

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 R

rvice Experience (Recent entry first )

IMO DWT GRT KW Engine type

9460772 80,383 43,790 13,545 Man B,W 7S50mc

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 REC01

Company Year Built

National navigation
2010
company

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