Application Form OFC-007 (08-15)

Date of application: 08/07/2019 Please upload picture here

Name of manning agent:

General:
Last name: DERINDERE First name: IBRAHIM KURSAD
Date of birth: 19.03.1993 Place of birth: MİLAS
Address: BURGAZ MAH YENİ DEDE SOKAK MO 9 City: MUĞLA
Country: TURKEY Nationality: TURKISH
Telephone: +905469518373 Mobile: +905469518373
E-mail: Kursadderindere@gmail.com Skype ID: Kursadderindere
Position applying for: Deck officer
Available from: 08/07/2019

Sea history:
Vessel name Vessel Flag Rank DWT Maker, From Until Y/M/D Company
type model, (dd/mm/yyyy) (dd/mm/yyyy)
BHP/KW
Varkan Ege CHEM/OIL MALTA 2/O 8000 VARKAN
SHIPPING
SCOT CHEM/OIL MALTA 3/O 8184 SCOT TANKER
STUTTGART
AKDENİZ CHEM/OIL MALTA 2/O 12000 SCOT TANKER
SCOT CHEM/OIL MALTA 3/O 8184 03.11.2018 27.03.2019 SCOT TANKER
STUTTGART
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 Application Form OFC-007 (08-15)

Documents:
Document Country: Number: Place of Date of issue: Expiry date:
name: issue:
Passport: TURKEY U20705808 MİLAS 04.09.2018 17.03.2019
Seamans TURKEY S00263311 GÜLLÜK 15.05.2019 15.05.2024
book:
Others:

National license / endorsement:

Country: Number: Place of issue: Date of issue: Expiry date:
MALTA 175198 N/A 22.08.2017 14.01.2021
Highest rank on endorsement: OOW NAV.
Valid for chemical tankers: YES
Valid for oil tankers: YES

Other Flag State licenses:

Country: Number: Place of issue: Date of issue: Expiry date:

Medical examination:
Country: Date of issue: Expiry date:
TURKEY 09.08.2018 09.08.2020

Vaccination Yellow Fever:

Date of issue: Expiry date:
24.06.2013 24.06.2023

Maritime education:
Grade: School: Country: Date (from – to):
maritime transportation KARADENİZ TECHNICAL TURKEY 2011-2016
and management UNIVERSITY
engineering

Others:
Weight: 68
Height: 1,77
Marital Status: Single
Religion: MUSLIM
Nearest international airport BODRUM
Nearest domestic airport BODRUM
 Application Form OFC-007 (08-15)

Certifcates:
Date of issue: Expiry date:
Basic safety training, or: 30.11.2017 28.08.2022
Personal survival techniques 30.11.2017 28.08.2022
Fire prevention and fire fighting 30.11.2017 28.08.2022
Elementry First Aid 30.11.2017 28.08.2022
Personal Safety / Social Responsibility 30.11.2017 28.08.2022
Proficiency in survival craft / PSCRB 30.11.2017 28.08.2022
Advanced fire fighting 28.06.2016 28.06.2021
GMDSS 14.01.2016 14.01.2021
Medical care on board
Medical First aid 14.05.2019 -
Radar navigator 28.06.2016 -
Shiphandling (IMO model course 1.22) 06.05.2016 -
Bridge team and resource management 28.06.2016
Engine room resource management
Ship Security Officer 28.06.2016 28.06.2021
Designated Security Duties 14.05.2019 -
ECDIS (generic – IMO model course 1.27, 40 hrs.) 28.06.2016 -
ECDIS JRC type specific training 09.05.2017
ECDIS FURUNO type specific training
ECDIS TOTEM type specific training
Tanker familiarization 28.06.2016 28.06.2021
Advanced chemical training 28.06.2016 28.06.2021
Advanced oil training 28.06.2016 28.06.2021
Ship Safety Officer 11.05.2016 -
Ships Cook training certificate
Steward/Messman certificate

Visa:
Date of issue: Expiry date:
US Visa (C1/D) 10.10.2018 26.09.2023
Schengen visa

Next of kin: ŞENOL DERİNDERE Relationship:FATHER

Telephone:+905467237491 Date of birth:14.02.1964
Address:BURGAZ MAHALLESİ YENİ DEDE SOKAK NO 9 MUĞLA / MİLAS

No. of dependents
Relationship: Name: Date of birth:
Relationship: Name: Date of birth:
Relationship: Name: Date of birth:
Relationship: Name: Date of birth:
 Application Form OFC-007 (08-15)

Tanker Information Sheet - (For applications of Deck Officers, Bosun and Pumpman)

YES/NO Year* Rank** Yes/No Year* Rank**

Chemical Products Chemical Products
Aromatics: Perchlorethylene - -
Styrene - - Trichlorethylene - -
Toluene YES 2017- 2/O MDI/TDI - -
2018
Benzene YES 2017- 2/O Ethylene/Methylene Dichloride - -
2018
Xylene YES 2017- 2/O Styrene Monomer - -
2018
Alcohols & Glykols - - MethylTert-Butyl Ether (MTBE) - -
Methanol - - Butyl Acetate - -
Ethanol - - Acetone - -
Iso-propyl Alcohol (IPA) - - Acrylonitrile - -
Butyl /Isobutyl Alcohol - - Caustic Soda - -
2-Ethylhexanol (Octanol) - - Chloroform - -
Mono Ethylene Glycol (MEG) - - Phenols - -
Molasses YES 2019 - Propylene Oxide - -
Acids: Vinyl Acetate Monomer (VAM) - -
Phosphoric - - Urea Ammonia Nitrate - -
Sulphiric - - Dowanol - -
Acrylic - - - -
Acetic - - Clean Petroleum Products (CPP):
Paraffins: Gasoil /Diesel Oil YES 2017- 3/O
2018-
2019
Slack Wax - - ULSD - -
Hexane - - Gasoline YES 2017- 3/O
2018-
2019
Cyclohexane - - Naphta YES 2017- 3/O
2018-
2019
Vegoils: Fuel Oil - -
Such as Crude Palm Oil, YES 2017- 3/O Luboils YES 2017- 3/O
Rapeseed Oil, Soyabean Oil, 2018- 2018-
Sunflower Oil, etc. 2019 2019

*Year: enter year of latest experience **Rank: enter highest rank of experience

Parcel Trade Exp. (max. no during single voyage): YES – 4 PARCEL

Cargo Pumps Experience Tank’s Coating Type Experience
Deepwell: - Expoxy -
Framo YES Zinc Silicate -
Marflex (electrical driven) YES Marineline YES
Centrifugal - Stainless Steel -
Screw - Tank’s Passivation Experience -
Steam Turbine - Wall Wash Experience YES

Vetting Inspections (indicate which) YES

CDI Inspection (indicate date of last inspection) YES
OCIMF Inspection (indicate date of last inspection) YES
 Application Form OFC-007 (08-15)

USCG Inspection (indicate date of last inspection) NO

Dry Dock Experience (indicate shipyard) YES
Experience in Delivery of New Buildings NO
Trading Area (indicate areas)
Ice Navigation Experience (indicate areas) NO
Ship-to-Ship Experience (indicate areas) YES