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					CREW DATA SHEET                          "Georgian Sea Gate"Ltd
PERSONAL DATA                                                                              NAME:

PERSONAL DETAILS

     Position:                                                  Alternate:

      Vessel:                                                                 Flag:

   Surname:

  First Name:                                             Middle Name:                                                             Photo

      D.o.B.:                                P.o.B.:

  Nationality:                                         Sex :

 Civil Status:                                 No. of Children / Dependent:

ADDRESS

       Street:                                                                                 Tel:
          City:                                                                                Tel:
     Country:                                                                                 Fax:
      Airport:                                                                             E-mail:

NEXT OF KIN

       Name:                                                                                 Tel * :
    Relation:                                                                              Fax * :
       Street:
City/ Country:                                                                                         * If same as above, please insert "As above"

NATIONAL IDENTITY DOCUMENTS / VISA

Passport No:                                                                       Issued:                               Expiry:

SB-Book No:                                                                        Issued:                               Expiry:

  US - VISA:                                                                       Issued:                               Expiry:

  Other Visa:                                                                      Issued:                               Expiry:

LANGUAGES

   Level of English                                                                 Test passed                    Date :

 Mother Language                                                                        Remarks
  Other Languages

MEDICAL EXAMINATION

       Clinic:                                                                     Issued:                               Expiry:

VACCINATIONS (VALID FOR DURATION OF CONTRACT)
                                                                                                                                   1. SHOT 2.SHOT 3.SHOT

     Cholera:                Yellow Fever:                Typhoid:               Tetanus:                      Hepatitis:

DRUG AND ALCOHOL TEST
                                                                                                                                            NEG       POS

       Clinic:                                                                     Issued:                                      Result:
                  IF TEST RESULTS ARE POSITIVE, PLS STATE REASON (E.G. PRESCRIBED MEDICATION ETC.)

SIZE OF             Shoes                                 Overall


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CREW DATA SHEET                       "Georgian Sea Gate"Ltd
EXPERIENCE                                                                         NAME:

TRAINING COURSES               (All Training courses / Seminars / Upgrading courses other than STCW/Flag state requirements)


Training Course / Seminar                                      Location                                       Duration           Date




SEA SERVICE             (Complete sea service record for at least last 9 employments)


    Name of vessel          Flag            Type           Engine               Company                Rank              S/on     Months/
                         Year built         GRT               kW               Crew Agent                 .              S/off     Days




                                                                Page 2
CREW DATA SHEET                                  "Georgian Sea Gate"Ltd
QUALIFICATION STCW95                                                                 NAME:

1. BASIC STCW (A-VI/1)
                           DATE OF ISSUE         DATE OF EXPIRY                                 DATE OF ISSUE   DATE OF EXPIRY

           PERSONAL                                                                    FIRE
   1.1
            SURVIVAL                                                               FIGHTING
                           DATE OF ISSUE         DATE OF EXPIRY                                 DATE OF ISSUE   DATE OF EXPIRY

   1.2 ELEMENTARY                                                                 PERSONAL
            FIRST AID                                                               SAFETY

2. STCW - CERTIFICATES (A-VI/2-4)
                           DATE OF ISSUE         DATE OF EXPIRY                                 DATE OF ISSUE   DATE OF EXPIRY

   2.1        RESCUE                                                                MEDICAL
               BOATS                                                               FIRST AID
                           DATE OF ISSUE         DATE OF EXPIRY                                 DATE OF ISSUE   DATE OF EXPIRY

   2.2 FAST RESCUE                                                                 MEDICAL
                BOATS                                                                CARE
                           DATE OF ISSUE         DATE OF EXPIRY
           ADVANCED
   2.3
                FIRE

3. CERTIFICATE OF COMPETENCY (A II/1-4, A III/1-4)
                                                                                                DATE OF ISSUE   DATE OF EXPIRY

   TYPE OF LICENSE                                        No.

4. ADDITIONAL CERTIFICATES (A II/1, A IV)

              RADAR                                                                  GMDSS
   4.1                                                   ARPA                                                           ECDIS
           OBSERVER                                                                    GOC

5. SPECIAL REQUIREMENTS TANKER (A V/1)
                           DATE OF ISSUE         DATE OF EXPIRY                                 DATE OF ISSUE   DATE OF EXPIRY

          Shore based                                                              Oil Tanker
   5.0
          Fire Fighting                                                            Advanced
                           DATE OF ISSUE         DATE OF EXPIRY                                 DATE OF ISSUE   DATE OF EXPIRY

   5.1        TANKER                                                             Chem Tanker
         Familiarization                                                            Advanced
                                                   OIL    CHEM    GAS                           DATE OF ISSUE   DATE OF EXPIRY

                                      covering                                    Gas Tanker
                                                                                   Advanced
                           DATE OF ISSUE         DATE OF EXPIRY                                 DATE OF ISSUE   DATE OF EXPIRY

         Bridge Team                                                                    COW
         Management:                                                                Inert Gas

8. ANY OTHER ADDITIONAL QUALIFICATIONS




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