Online Application Max Square Enterprise Co.,Ltd. Post Applied for ---MasterC/O (Under 3000)C/O (Unlimited)2/O3/OBSNCarpenterII/5 ABII/4 ABDR (or) DCOS (or) GSMess BoyCOOKCE (Under 3000)CE (Unlimited)1/E2/E3/E4/EFitterN0.1 OilerIII/5 OilerIII/4 OilerER (or) ECWiperE/EETO (or)ETRJ/ESTWD Readiness PERSONAL DETAILS Name Date of Birth Age Place of Birth Religion Marital Status Height Weight Education Mark Father Name Mother Name Shoe size Overall size Next of Kin Relation Address Phone Email SEAMAN’S DOCUMENTS No Holding Certificates Number Date Of Issues Date Of Expire 01 Passport ( PP) 02 Seafarer Identification and Record Book (SIRB) 03 Certificate of Competency (COC) 04 GOC / GMDSS (SOLAS – 74 – STCW -78 ) 05 G.O.C (Endorsement )(STCW-95- I/2) 06 Radar Observer (STCW-95-II/2) 07 Radar And ARPA (STCW – 95 –I/2) 08 S.S.O (ISPS-CODE-PART-A,P-12& PART B-P-13) 09 Advanced Fire Fighting (STCW-95-A-VI/3) 10 Medical First Aid (STCW-95-A.VI/4-1) 11 Medical Care (STCW-95-A-VI/4-2) 12 Tanker Familiarization (TF) 13 Advanced Oil Tanker Operation (STCW-95-A-V/I) 14 Advanced Chemical Tanker Operation (STCW-95-V/I-2) 15 Advanced Gas Tanker Operation (STCW-95-A-V/I) 16 Hazardous Cargo Training (STCW-95) (HCT) 17 Bridge Team Management (BTM) 18 Bridge or Engine Resource Management (BRM) or (ERM) 19 ECDIS 20 ESDIS (Type Specific) 21 Basic Safety Training (BST) 22 Efficient Deck Hand ( E.D.H) 23 Watch keeping (WK) 24 Engine Room Watch (ERW) 25 Survival Craft And Rescue boat (PSCRB) 26 Ship Security Awareness (SSA) 27 Designated Security Duties (DSD) 28 High Voltage Training (HVT) 29 Hazardous Cargo Training (HCT) 30 Cook Certificate 31 Other Certs ( Malaysia / Hong Kong / Liberia/ Panama ) SEA SERVICE RECORD (FROM LAST TO FIRST) No Name of Vessel Rank Type GRT BHP Main Engine Sign On Sign Off Ship Owner 01 02 03 04 05 06 07 08 Requirements YES No IF YES, PLEASE PROVIDE DETAILS Expected Wages Yes No Required Ship Gross Tonnage Yes No Requited Ship Type Yes No Remark: I confirm that, the information given by me herein is above mentioned data are true correct. All documents are authentic, not fraudulence. Name CDC DATE Input this code: