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SEAFARER'S APPLICATION FORM - Page 1 of 3 - PERSONAL DATA

PERSONAL INFORMATION
Family Name TOPCHIEV First Name (s) German
Birth Date 13.07.1965 Birth Place Baku USSR
Nationality Russian Religion Orthodox
Marital Status Married No. of C hildren one
Height (cm) 183 Weight (kg) 90
Nearest Airport Pulkovo Size of overall/ shoes 56/42
ADDRESS (include telephone country & area codes, advise also secondary or contact addresses if any)
Street & Nr. 28,,A”ap.2 Tkachey street

Email Address German130765@mail.ru
Mobile Phone 8-905 -204 -34 -18
City Saint -Petersburg Residence Phone (812)568 48 78
State, Country Russia Skype Tgg65mf
Postal (ZIP) Code 192029 P.O. Box (if any)
NEXT OF KIN INFORMATION (person to contact in case of emergency & insurance beneficiary)
Family Name Danilova First Name(s) Natalia
Nationality Russian Relationship Mother of my son
Street & Nr. 28,,A”ap.2 Tkachey street Email Address
Location Nevskiy district Mobile Phone 8-965 -031 -24 -72
City Saint -Petersburg Re sidence Phone (812)568 -48 -78
State, Country Russia Fax
Postal (ZIP) Code 192029 P.O. Box (if any)
REMARKS
Requested Rank 2nd Eng. Ch.Eng. Availability Date
Prefer. Vessel Type All types of ships Minimum Salary
English Language Skills Spoken: fluent / good / average / poor - Written: fluent / good / average / poor
Other Foreign Languages
Foreign Crew Experience
(specify nationalities)
Japanese; Korean;New -Zealander;Norwegian;German;Polish;Romanian;
Argentinean;Chilean;Philipino;Dutchman,Indian ,Bulgarian,African;Indonesian
Other Skills
Further Remarks
I hereby affirm that all the information provided by me in this application is true and correct to the best of my knowledge.
Date:

Signature:

SEAFARER'S APPLICATI ON FORM - Page 2 of 3 - LIST OF DOCUMENTS


Family
Name Topchiev First
Name(s)
German Rank 2nd Engineer
A. TRAVEL DOCUMENTS AND MEDICAL CERTIFICATES
Document Name (Desciption) Document Number Country Issue Place Issue Date Exp. Date
Passport 76 2904838 Russia St-Petersburg 25.03.20 25.03.30
Seaman's Book (national) MK 0079340 Russia St-Petersburg 23.06.11 Permanent
Seafarer’s Identity Document RUS 0492914 Russia St-Petersburg 24.02.21 23.02.26
Seaman's Book (Netherlands) 0126 0976 Dutch Vlissingen 26.10.09 26.10.19
Seaman's Book (Antigua&Barbuda) 148125 Ant&Barb St.Johns 26.11.15 25.11.20
Seaman’s Book (Deutschland ) 37/13 Germany Kil 22.05.13 Permanent
Seaman’s Book (Cyprus) CY 071324 Cyprus Lemesos 07.10.04 07.10.14
Visa - United States (type С1/D)
(USA)
2020 3220380002 USA Moscow 19.11 .20 16.11.22
Visa - Others (Shengen)

013032277 Dutch SPB 07.11.17 07.11.20
Visa - Others (Shengen) 000095172 Greece Moscow 08.11.20 07.11.22
Medical Examination Report







28428261

30640
Russia Med.Cent.
Baltiyski

25.01.2021 25.01.2022
Medical Examination Report (Dutch)

01260976 Netherlands SPB 03.06.20 02.06.22
Med.Exam.Report (Deutschland) Germany Hamburg 22.05.13 22.05.15
Drug & Alcohol Test Russia Med.C ent.
Baltiyskiy

25.01 .2021
Vaccination against Yellow Fever 30640 Russia Med.Cent.SPB 08.10.09 Permanent
Vaccination against Cholera 30640 Russia Med.Cent. 27.10.2015
Passport Photos please mail 6 for deck officers & 4 for other ranks (required f or flag states)
B. CERTIFICATES OF COMPETENCY & ENDORSEMENTS, COURSE CERTIFICATES
- deck & engine certificates & endor -
sements (officers / ratings)
- electrical & reefer certificates
- cook & steward certificates
- radio certificates & endorsements
- safety training (surv., fire, medical)
- tanker courses (oil, chem., gas)
- passenger vsl, roro, hazmat courses
- nav., deck, technical & management
courses (radar/ARPA, ISM, Marpol,
simulators, computer, welding etc.)
- any flag state certificate s
Document Name (Desciption) Document Number Country Issue Place Issue Date Exp. Date
CERT. OF COMPETENCY:
Chief Engineer
LED204672966 Russia AMP”BP”
SPB
05.02.2021 09.12.2025
CERTIFICATE OF COMPETENCY
Chief Engineer
8600075963/200525 Netherlands Amste rdam 31.08.16 15.04.21
CERTIFICATE OF COMPETENCY
Chief Engineer
BSH -2013 -73 -0121 Germany Hamburg 04.09.13 06.04.16
CERTIFICATE OF COMPETENCY
Chief Engineer
RE 00859811 Cyprus Lemesos 23.11.11 06.04.16
CERTIFICATE OF COMPETENCY
Chief Engineer
PT20190R BE000334
701
Portugal Portugal 01.03.19 15.04.21
CERTIFICATE OF COMPETENCY
Chief Engineer
12316 Bahrain Bahrain 14.10.19 15.04.21
CERTIFICATE OF COMPETENCY
Chief Engineer
59939 Malta Malta 03.03.20 15.04.21
TANKER ENDORSEMENT
OPERATIONAL
LED 20467297 7 Russia AMP”BP”
SPB
05.02.2021 09.01.2025
TANKER ENDORSEMENT
MANAGEMENT
1011121666 Russia AMP”BP”
SPB
29.04.2013 06.04.16
Oil tanker Familiarization course

Liquefied gas tanker Familiarization
course

Basic Training for Oil and Chemical
Tank er(Section A -V/1 -1, tableA -V/1)
m



674 -363/20 -02C
Russia MARSTAR
SPB
30.12.2020 30.12.2025
Oil tanker Specialized course 0910129 Russia MARSTAR
“PEI”SPB
13.01.2021 13.01.2026
Chemical tanker Specialized course 0777191 Russia MARSTAR
“PEI”SPB
15. 01.2021 15.01.2026
BASIC SAFETY TRAINING 620 -352/ 20 -10С Russia MARSTAR. 18.12.2020 18.12.2025
PROFICIENCY IN SURVIVAL
CRAFT
622 -358/ 20 -05C Russia MARSTAR
“PEI”SPB 23.12.2020 23.12.2025
ADVANCED FIRE FIGHTING 625 -359/20 -07C Russia MARSTAR 24.12.2021 24.12.2025
MEDICAL CARE
MEDICAL FIRST AID 628 -349/20 -25C Russia MARSTAR 16.12.2020 16.12.2025
CARRIAGE OF DANGEROUS
AND HAZARDOUS
SUBSTANCES(Sections B -V/b)

697 -022/21 -01C

Russia


MARSTAR
“PEI” SPB


25.01.2021


25.01.2026

SHIP SECURITY OFFICER
TRAINING
634 -356/20 -05C Russia MARSTAR
“PEI” SPB
22.12.2020 22.12.2025
Hazardous cargoes”C”49 of the US 698 -360/20 -02C Russia MARSTAR 25.12.2020 25.12.2023
A+B GMDSS ENDOR
Passenger and cargo safety and hull
integrity training at the management
0675642 Russia MARSTAR “PEI” SPB 22.01.2021 22.01.20 26
Operation of electrical installation,
Electrical control systems on board
07/2015 Russia MARSTAR “PEI” SPB 25.09.15 25.09.20
SERTIFICATE MOTORMAN 1024301167 Russia AMP
Arkhangelsk
21.06.03 06.04.16
Date:


Signature:

SEAFARER'S APPLICATION FORM - Page 3 of 3 - SEA SERVICE (LAST 10 YEARS)

Family Name: Topchiev First Name(s): German Date of Birth: 13.07.1965
Vessel's Name Flag GT kW Ship Type Eng.Make Rank S/On Date S/Off Date Employer (company to contact for reference)
PLANCIUS Dutch 3434 3812 passenger SWD
8FCHD24/
90
2nd Eng 26.10.09 05.05.10 Oceanwide Mar.Serv.Netherlands+31 118 413748
BBC BALTIC Antiq.Barb. 5261 3840 Mult.Purp MAK
8M32C
2nd Eng 16.09.10 28.01.11 Briese Swallow:St -Petersburg (812)336 -80-03
Sea Discovery Cyprus 6872 5438 Timber
сarrier
MAN
B&W
8L32/40
2nd Eng 26.12.11 14.05.12 Interorient:St -Petersburg (812)326 -87-20
Hanseduo Antiq.Barb 8350 5300 Cоntainer Deutz
SBV6M540
2nd Eng 10.08.12 18.10.12 Interorient:St -Petersburg (812)326 -87-20
ANNA SIRKA Germany 9981 8400 Container MAK
9M43C
2nd Eng…. 22.05.13 29.09.13 Reederei Petra Heinrich KG MS’’Anna Sirkka”
GmbH&Co Germany tel;04162/90 -98-29
EEBORG Dutch 7680 4500 General
cargo
Wartsila
9L32C
2nd Eng 21.11.13 21.03.14 Wagenborg Shipping B.V:Marktstraat 10 P.O
Box 14 9930 AA Delfzijl the Netherlands
FRASERBORG Dutch 8911 4500 General
cargo
Wartsila
9L32C
2nd Eng 03.05.14 08.08.14 Wagenborg Shipping B.V: Markstraat 10 P.O
Box 149930 AA Delfzijl the Netherlands
KEIZERSBORG Dutch 6142 3960 General
cargo
Wartsila
6L38
2nd Eng 10.10.14 25.01.15 Wagenborg Shipping B.V;Markstraat 10 P.O
Box 149930 AA Delfzijl the Netherlands
FRASERBORG Dutch 8911 4500 General
cargo
Wartsila
9L32C
2nd Eng 11.04.15 10.08.15 Wagenborg Shipping B.V;Markstraat 10 P.O
Box 149930 AA Delfzijl the Netherlands
SOPHIA Antigua&
Barbuda
7464 7200 Container MAK
8M43C
2nd Eng 03.12.15 13.03.16 Kapt. Manfred Draxl Schiffahrts GMBH
Zeppelinstr 32 D -49733 Haren/Ems. Germany
MERWEBORG Dutch 6540 5280 General
cargo
Wartsila
8L38
2nd Eng 27.08.16 23.12. 16 Wagenborg Shipping B.V;Markstraat 10 P.O
Box149930 AA Delfzijl the Netherlands
VECHTBORG Dutch 6130 3960 General
cargo
Wartsila
6L38
2nd Eng 05.04.17 27.06.17 Wagenborg Shipping B.V;Markstraat 10 P.O
Box149930 AA Delfzijl the Netherlands
MOEZELBO RG Dutch 6540 5280 General
cargo
Wartsila
8L38
2nd Eng 13.09.17 19.12.17 Wagenborg Shipping B.V;Markstraat 10 P.O
Box149930 AA Delfzijl the Netherlands
DONGEBORG Dutch 6205 5280 General
cargo
Wartsila
8L38
2nd Eng 09.03.18 12.06.18 Wagenborg Shipp ing B.V;Markstraat 10 P.O
Box149930 AA Delfzijl the Netherlands
INDUSTRIAL COURAGE Portugal 7498 3950 Heavy Lift Wartsila
WIN GD
W6X35 -B
2nd Eng 07.01.19 10.05.19 Peter Dohle Schiffahrts -KG:Elbchaussee370,
22609;Hamburg, Germany

GIBRALTAR Bahrain 7086 6500 Dredger MAK
8M32C
2nd Eng 10.10.19 22.12.19 Arch.Makarlou III,284 Fortuna Court Block B,
2nd Floor,PC 3105, Limassol. Cyprus
MOEZELBORG Dutch 6540 5280 General
cargo
Wartsila
8L38
2nd Eng 14.06.20 14.09.20 Wagenborg Shipping B.V;Markstraat 10 P.O
Box149930 AA Delfzijl the Netherlands








ADDITIONAL INFORMATION:
Reefer container experience m/v Athl ete -F; m/v Cosco Damman; m/v Cosco Melbourne; m/v Hanseduo;m/v Anna Sirka; m/v Sophia;
USA Coast Guard inspection attended m/v Fraserborg 10.05.2014; Industrial Courage 12.05.2019:
Experience with ship cranes (type & mark ) MacGregor GL4024x40t; Liebhe rr cran -40t; MacGregor -2x150; Gantry -12t:
Yard deliveries taken m/v Azov Coast in Turkey -2007y; m/v Plancius in Netherlands -2009y:
Reason for leaving previous company There were no free vacancies on vessels in Wagenborg shipping company

WAGENBORG SAINT -PETERSBURG (812)7149805
Date:


Signature: