F.Crew.

01

Rev - 03 (01-July-2020)

Date - 14.09.2018

USHIN-G REF

REFERENCE NO.

REFERRED BY

PREVIOUS COMPANY

CONTACT

APPLIED DATE

PERSONAL INFORMATION

NAME

NATIONALITY

DATE OF BIRTH

HEIGHT (CM)

BLOOD

NATIONAL ID

SHOE SIZE

HOME ADDRESS

PHONE 1

PHONE 2

EMAIL
NEXT OF KIN

NAME OF NOK

PHONE

ADDRESS

EDUCATION

SCHOOL/COLLEGE/UNIVERSITY CITY + COUNTRY

CERTIFICATES

GRADE NUMBER

PASSPORT

CDC

SID

ALL IN ONE

GMDSS

BST

PSC & RB

AFF

AMC

SSA

SSO

TF
AOT

ACT

MFA

RADAR

ARPA

ECDIS (EGNERIC)

ECDIS (SPECIFIC)

DSD

BTM/ ERM

USA VISA C1/D

MEDICAL

NUMBER

MEDICAL CERTIFICATE

YELLOW FEVER

CHOLERA

EQUIVALENT ENDORSEMENT

LICENSE

GRADE NUMBER

BAHAMAS

HONG KONG

SINGAPORE

PANAMA

MARSHALL ISLAND

OTHER

VESSEL -1

VESSEL NAME

IMO

FLAG

TYPE

GT
TEU

KW

TYPE OF M.E

TYPE OF G.E

RANK

NATIONALITY OF CREW

TRADING AREA

DATE OF EMBARK

DATE OF DISEMBARK

DURATION (MONTHS)

REASON OF SIGN-OFF

MANAGEMENT

MANNING AGENCY

VESSEL -5

VESSEL NAME

IMO

FLAG

TYPE

GT

TEU

KW

TYPE OF M.E
TYPE OF G.E

RANK

NATIONALITY OF CREW

TRADING AREA

DATE OF EMBARK

DATE OF DISEMBARK

DURATION (MONTHS)

REASON OF SIGN-OFF

MANAGEMENT

MANNING AGENCY
USHIN-G REFERENCE
PHOTO

FOR SHIP

RANK

PLACE OF BIRTH

WEIGHT (KG)

RELIGION

MARITAL STATUS

BOILER SUIT SIZE

SKYPE ID

WECHAT

FATHER NAME
 RELATION

NO. OF CHILDREN

CITY + COUNTRY FROM YEAR TO YEAR SPECIALIT

NUMBER ISSUE DATE EXPIRED DA

NUMBER ISSUE DATE EXPIRED DA

LICENSE GMDSS

ISSUED DATE EXPIRY NUMBER ISSUED DATE

SEA SERVICES

VESSEL -2 VESSEL -3
VESSEL -6 VESSEL -7
Ushin-G Company Limited

AGE

BMI
 SPECIALITY DEGREE

ISSUING PLACE OF
EXPIRED DATE AUTHORITY ISSUE
 ISSUING PLACE OF
EXPIRED DATE AUTHORITY ISSUE

SS OTHER

EXPIRY NUMBER EXPIRY

VESSEL -4
VESSEL -8