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APPLICANT’S PERSONAL DATA

POSITION OR RANK: Сh.Off/ Master license DATE OF READINESS: Ready WAGES:

FAMILY NAME ANDRUKHOV CITIZENSHIP: Russia, Moldova - EU
passport



FIRST NAME SERGEI ADDRESS (full mail style): Russia 236001
Kaliningrad , Iva na Susanina 3 8 FATHER’S NAME N/A
DATE OF BIRTH 11.11.1966
PLACE OF BIRTH Moldova Nearest Airport : Kaliningrad , Moscow
E-MAIL scorp.as.gus@gmail.com HOME PHONE: -
OTHER CONTACTS gumguss14@yandex.ru MOBILE PH. : +7 958 142 36 28
MARITAL STATUS Married NEXT OF KIN INFORMATION:
WIFE’S FAMILY NAME ANDRU KHOVA RELATION:
WIFE’SFIRST NAME IRA FAMILY NAME :
WIFE’S FATHER’S NAME N/A FIRST NAME:
DATE OF BIRTH 29.01.1966 FATHER’S NAME:
ADDRESS (full style): Russia 236001 Kaliningrad ,
Susanina 38


CONTACT PHONE: CONTACT PHONE:
Family/First//Middle Name of FATHER (Date of birth) Family (maiden name)/First//Middle Name of MOTHER (DOB)
n/a n/a
CHILDREN’S LAST/FIRST NAME (UNDER 18) : CHILDREN’S DATE OF BIRTH : Number of kids
n/a n/a CLOTHES SIZE CLOTHES SIZE HEIGHT (Cms) 185 OVERALL (digit size) 52 SWEATER (digit size) 52 WEIGHT (Kgs) 75 SAFETY SHOES 43 SHIRT (size around neck) COLOR OF EYES Grey TROUSERS 34 COLOR OF HAIR brown

MARINE EDUCATION RECEIVED FROM TILL TYPE OF DEGREE RECEIVED
Kaliningrad Marine College 01.09.2001 22.06.2002 Navigator
PASSPORT / SBK ISSUED BY NO. ISSUE DATE VALID TILL
SEAFARER’S INDENTITY DOCUMENT Kaliningrad Sea Port Rus 0 631105 29 .11.2023 28 .11.20 28
RUSSIAN SEAMAN’S BOOK Kaliningrad Sea Port MK 0 210207 03.02.2014
TRAVELLING PASSPORT Moldova AP0315824 13.10.2023 13.10.2033
TRAVELLING PASSPORT Russia 75 5293448 30.06.2017 30.06.2027
GRADE NO. ISSUE DATE VA LID TILL
NATIONAL LICENCE: KGD2 09490677 23.03.2026 19.0 2.20 31
ENDORSM : OI L Chem LPG
GMDSS : Gen. Oper. Restr Oper. 4.04.0061/2026 26.02.2026 26.02.2031
GMDSS ENDORSEMENT KGD 209490 644 23.03.2026 19.02.2031 CERTIFICATE STCW CODE NO ISSUED VA LID TILL
BASIC SAFETY TRAINING A-VI/1 -4,
MSC.560 1.01.0151 22.01.2026 22.01.2031
ADVANCED FIRE FIGHTING : A-VI/3 1.02.0049/2026 20.01.2026 20.01.20 31
PROFICIENCY IN SURVIVAL CRAFT, RESCUE B. A-VI/2-1 1.03.0094/2026 26.01.2026 26.01.2031
MEDICAL FIRST AID A-VI/4 -1 1.05.0002/2026 16.01.2026 16.01.2031
MEDICAL CARE CERTIF. A-VI/4-2 1.06.0464/2026 23.12.2025 23.12.2030
SHIPBOARD SAFETY OFFICER 40 -012/22 02/02/2022 n/a
SHIP SECURITY OFFICER A-VI/5 1.09.0240/2024 21.06.2024 21.06.2029
RADAR OBSERVER VATION AND PLOTTING A-I/12, B -I/12 2.01.0160/2026 03.03.2026 03.03.2031
ARPA (AUTOMATIC RADAR PLOTTING AIDS) A-I/12, B -I/12 2.02.0156/2026 05.03.2026 05.03.2031
ECDIS B-I/12, AII/1 -3 1524351 06.03.2026 06.03.2031
SPECIFIC ECDIS – TRANSAS Navi Sailor 4000 2012 -LT -NOV -
NS40 -0018
11.09.2012 N/A
SHIPHANDLING AND MANOEUVRING A-II/2,A -
VIII/2,B -VIII/2
1-4,B -I/12
PARA68
2.05.0021/2025

19.06.2024

19.06.2029
BRIDGE TEAM & RECOURCES MANAGEMENT 146/2 021 18.06.2021 18.06.2026
ICE NAVIGATION TRAINING COURSE 33 -040/17 22.06.2017 N/A ADVANCED TRAINING FOR OIL TANKER 3.08.0001/2025 04.02.2025 04.02.2030
ADVANCED TRAINING FOR CHEMICAL TANKE 3.09.0001/2025 06.02.2025 06.02.2030

HEAL TH CERTIFICATE Issued by Kaliningrad General MC Date of issue 19.03.2026 Valid till 19.03.2027
YELLOW FEVER Issued by Kaliningrad General MC Date of issue 01.07 .20 17 Valid till 01.07.2027

OTHER DOCUMENTS ISSUED BY NO ISSUED VALID
BTM (B -VIII -2) / BRM Kaliningrad Training
Center 146/2021 18.06.2021 18.06.2026
SH (Ship’s Handling & Maneuvering) Kaliningrad Training
Center 2.05.0021/2024 19.06.2024 19.06.2029
ECDIS SPECIFIC TRAINING NOVIKONTAS
MARITIME
COLLEGE
2012 -LT -NOV -
NS40 -0018
11.09.2012 N/A
ENGL ISH KNOWLEDGE (tick) EXCELLENT GOOD MODERATE SATISFACTORY POOR
Name of English test MARLINS Date 28.09.2015 Result (% or rate) 87

VISAS (IF VALID) No PLACE OF ISSUE
(city/country) ISSUE DATE VALID TILL
USA
SCHENGEN
MCV (Australian Maritime Crew Visa)

FLAGS DOCUMENTS (INSERT FLAG NAME IN GREY BOX ; NIS, LIBERIA, CYPRUS, PANAMA etc )
GRADE NBR ISSUED TILL GRADE NBR ISSUED TILL
SBK SBK
LICENSE LICENSE
GMDSS GMDSS
SPECIAL SPECIAL

SBK SBK
LICENSE LICENSE
GMDSS GMDSS
SPECIAL SPECIAL SEA SERVICE LAST 10 YEARS
VESSEL’S NAME SHIP’S OWNER OR MANAGER FLAG VESSEL TYPE GRT ENG. TYPE kW RANK FROM dd/mm/yyyy TO dd/mm/yyyy
Hafnia Henriette Hafnia tankers Malta Oil/Chem 50000 Ch.Off 26.07.202 1 06.12.2021
Hafnia Henriette Hafnia tankers Malta Oil/Chem 50000 Ch.Off 11.04.2022 27.07.2022
Hafnia Henriette Hafnia tankers Malta Oil/Chem 50000 Ch.Off 08.10.2022 11.03.2023
Hafnia Henriette Hafnia tankers Malta Oil/Chem 50000 Ch.Off 23.06.2023 25.09.2023
Hafnia Lene Hafnia tankers Malta Oil/Chem 50000 Ch.Off 04.01.2024 13.04.2024
Hafnia Lene Hafnia tankers Malta Oil/Chem 50000 Ch.Off 01.08.2024 04.11.2024
Hafnia Lene Hafnia tankers Malta Oil/Chem 50000 Ch.Off 22.02.2025 05.06.2025
4 LAST CREWING AGENCIES / OWNERS CONTACT DETAILS
COMPANY NAME TEL/FAX /E-MAIL CONTACT PERSON


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