Personal Details s10

Date Revision Page July 30, 2012 5 Approved by: Managing Director 1 of 2 SEAMAN DETAILS / CV C 033

RANK PERSONAL DETAILS FULL NAME: Sex: M F PLACE OF BIRTH: DATE OF BIRTH : ADDRESS: PHONE: FAX: e-mail: CITIZENSHIP MARITAL STUTUS Married Single Number of Children(s) : NEXT OF KIN NAME AND ADDRESS Phone FOREIGN LANGUAGES 1) 2) 3) DOCUMENTS & CERTIFICATES TYPE NUMBER PLACE & DATE OF ISSUE EXPIRY PASSPORT / NATIONAL SEAMAN BOOK / NATIONAL LICENCE/COMPETENCY /

COMPETENCY CERT (TYPE/CLASS) / ADMINISTRATION ACCEPTANCE DATE:

WATCHKEEPING CERT. (Rating) ENDORSEMENT APPLICATION MEDICAL FITNESS CERT

OTHER LICENCE NUMBER PLACE & DATE OF ISSUE EXPIRY

OTHER SEAMAN BOOK NUMBER PLACE & DATE OF ISSUE EXPIRY

TRAINING COURSES ATTENDED COMPANY REQUIREMENTS Mandatory (M) & Recommended (R) for certificate onto the various ranks Senior Officer Junior Officer Cadet Ratings ISSUE Non Type Place Deck Watch Galley Watch Date Deck Eng. Deck Eng. Engine Keeper Cabin Keeper Competence IMO (STCW) M M M M M M M Personal safety & Social Responsibility(PSSR) M M M M M M M M Survival at sea M M M M M M M M Medical care M M Medical First Aid M M M M M M Basic Fire-fighting M M M M M M M M Advanced Fire-fighting M M M M Radar Observer / ARPA M M R (Deck) Bridge Team Work M Bridge Team Management (5 years Interval) M M Bridge Resource Management R GMDSS (General Operator) M M Oil Tanker Familiarization (Type of ship) M M M M R M M M Oil Tanker safety (Type of ship) M M M R Chemical Tanker Familiarization M M M M R M M M Chemical Tanker safety M M M R MAMS -Survival Craft proficiency M M M M M ECDIS (Generic IMO Formal Course ) R1 R1 ECDIS Type Specific Familiarization R1 R1 Ship handling M R Messina Strait Transit R2 R Straits transiting (Malamocco) R2 Straits transiting (Bosporus & Dardanelles) R2 Heavy Weather Navigation (Simulator) M Ship Security Officer M Safety Officer - Risk Assessment – Accident M3 Incident Prevention /Investigation –Training IGS - C.O.W. ( in new Tanker safety cert.) R4 R4 CSM – Machinery Survey M (C/E) R Naval Automation R R HACCP M M M Note: 1 IMO Model Course 1.27 training Certificate and Type-specific ECDIS Familiarization (Manufacturers) training 2 Ship handling Course is Mandatory for Master with less than three years sea time or Ch. Off. To be promoted Master 3 In-house training based on STCW Tables A-II/2 & A-iii/2 & IMO Model course 3.11 4 IGS & COW Mandatory if not included in Tanker Safety certificates

AUGUSTA DUE SRL. Date Revision Page Approved by: Managing Director July 30, 2012 5 2 of 2 SEAMAN DETAILS / CV C 033

VESSEL EXPERIENCE (SEA TIME)

Main Engine Automation Type of Cargo New InfoSHIP Sign Off Vessel Name Type Owners DWT/GRT Rank From To Type/Power System Pumps Familiarization Reason

Place & Date Signature

AUGUSTA DUE SRL.