Name:

Rank:
Date of Birth:

CERTIFICATES AVAILABILITY ISSUE DATE EXPIRY DATE

PERSONAL
DOCUMENTS
Travel Passport Y ☐ N ☐ NA ☐

Seaman Book Y ☐ N ☐ NA ☐

ACADEMIC
CERTIFICATES
COP Y ☐ N ☐ NA ☐
Certificate of Competence Officer
in Charge of an Navigational
Watch (Ticket)
Certificate of Competence Officer Y ☐ N ☐ NA ☐
in Charge of an Engineering Watch
(Ticket)
General Operator’s Certificate for Y ☐ N ☐ NA ☐
GMDSS
GMDSS GOC (Ticket) Y ☐ N ☐ NA ☐
Ship Security Officer Y ☐ N ☐ NA ☐
RADAR, ARPA, Bridge Y ☐ N ☐ NA ☐
Teamwork and Search and Rescue
Management Level
Marine Radar, and Automatic Y ☐ N ☐ NA ☐
Radar Plotting Aids
ECDIS Y☐ N☐ NA ☐
ECDIS Advanced Y☐ N☐ NA ☐
Bridge Resource Management Y☐ N☐ NA ☐
Leadership and Teamwork Y☐ N☐ NA ☐
Advanced Communication Y☐ N☐ NA ☐
Medical Care Studies Y☐ N☐ NA ☐
Refreshment Course Engineering Y☐ N☐ NA ☐
Department (Management Level)
ISPS Code Familiarization Y ☐ N ☐ NA ☐
Certificate
High-Voltage Installation Y ☐ N ☐ NA ☐
Certificate
Engine Resource Management Y ☐ N ☐ NA ☐
Certificate
Marine Steam Turbine Certificate Y ☐ N ☐ NA ☐
TRAINING
CERTIFICATES

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Eikano Shipping & Trading SA . DATE OCT 2023
SAFETY MANAGEMENT SYSTEM MANUAL ISSUE
JOINING CREW CHECKLIST FOR OFFICERS FORM M-13
NO.1

Marine Environmental Awareness Y ☐ N ☐ NA ☐

Proficiency in Survival Craft and Y ☐ N ☐ NA ☐
Rescue Boats Other Than Fast
Rescue Boats
Proficiency of Security Awareness Y ☐ N ☐ NA ☐
Training for Seafarers with
Designated Security Duties
Basic Training and Security Y ☐ N ☐ NA ☐
Awareness Certificate
Personal Safety and Social Y ☐ N ☐ NA ☐
Responsibilities
Proficiency in Personal Survival Y ☐ N ☐ NA ☐
Techniques
Advanced Personal Survival and Y ☐ N ☐ NA ☐
Search & Rescue
Fire Prevention and Fire Fighting Y ☐ N ☐ NA ☐
Advanced Fire Prevention and Fire Y ☐ N ☐ NA ☐
Fighting Course
Elementary First Aid Y☐ N☐ NA ☐
Medical First Aid Y☐ N☐ NA ☐
Medical Care Y☐ N☐ NA ☐
Prevention and Combating of Y☐ N☐ NA ☐
Marine Pollution
MEDICAL
CERTIFICATES
Medical Report Y☐ N☐ NA ☐
Blood Analysis Y☐ N☐ NA ☐
Maritime Medical Certificate Y☐ N☐ NA ☐
Certificate of Oral Polio Y☐ N☐ NA ☐
Vaccination for International
International Certificate of Y ☐ N ☐ NA ☐
Vaccination
Covid-19 Vaccination Y ☐ N ☐ NA ☐
ENDORSEMENTS
COP Y ☐ N ☐ NA ☐
GMDSS CERTIFICATE Y ☐ N ☐ NA ☐
SECURITY CERTIFICATE Y ☐ N ☐ NA ☐

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