APPLICATION FORM F-100/10.02.

Page 1/5
Last reported: UIN= Rank:
First Name: Middle: Family name: Nationality:
CROAT
Date of birth: Place of birth Marital status:
Present address: Tel. Photo
Fax.: Next of kin & addr:
Mob.:
E - mail:
Educational history:
Colour of hair,eyes: Height Weight

License / country: Grade of license Date issued Place issued Number Date expires
Croatian
Liberian
Panamanian

Seaman's book country Seaman's book number Date issued Place issued Date expires Passport number Date issued
Croatia
Liberia Place issued Date expires
Panama
Last salary
PREVIOUS SEA EXPERIENCE ( FOR LAST FIVE YEARS OR LAST 10 SHIPS SERVED )
Deck: trade & dwt (TEU) Type of Managing company Sea Service
Vessel's name Flag Engineers: type & KW vessel Manning company Rank from to

Remarks / Schedule / Preferences if any: (type of ship, trade etc.) / Any additional info:

Sea service continued on the next page

Iva Shipping Ltd.

Date : Marasoviceva 67 Signature :
21 000 Split
http://www.iva-shipping.hr/ Croatia mailto:ivan.vodopivec@st.t-com.hr
 APPLICATION FORM F-100/10.02.
Page 2/5
UIN NAME RANK

PREVIOUS SEA EXPERIENCE ( ADDITIONAL SHIPS CONTINUED FROM MAIN PAGE )

Deck: trade & dwt (TEU) Type of Managing company Sea Service
No. Vessel's name Flag Engineers: type & KW vessel Manning company Rank from to

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25
References
Company name Full style address Contact person Tel. / Fax. / E-mail / Web page
1

Remarks
1 Number of newbuildings taken:
2 Number of drydockings:
3 Any additional info:

Iva Shipping Ltd.

Date : Marasoviceva 67 Signature :
21 000 Split
http://www.iva-shipping.hr/ Croatia mailto:ivan.vodopivec@st.t-com.hr
 APPLICATION FORM F-100/10.02.
Page 3/5
UIN NAME RANK

Certificate title Number Place of issue Date of issue Date expires

BASIC TRAINING
PROF. IN SURVIVAL CRAFT/RESCUE BOATS
PROFICIENCY IN FAST RESCUE BOATS
ADVANCED FIREFIGHTING
MEDICAL FIRST AID
ADVANCED MEDICAL CARE
DANGEROUS CARGO HANDLING
SHIP SECURITY OFFICER
RADIO
GENERAL RADIO OPERATOR
PANAMANIAN
LIBERIAN

TANKER
TANKER FAMILIARIZATION
ADVANCED OIL TANKER
ADVANCED CHEMICAL TAN.
ADVANCED LIQUIF. GAS
PANAMANIAN ADV. OIL TANKER STCW95
PANAMANIAN ADV. CHEMICAL STCW95
LIBERIAN OIL TANKER
LIBERIAN CHEMICAL TAN.

OTHER CERTIFICATES ( COURSES )

SHIP HANDLING
BRIDGE TEAM MANAGEMENT
BRIDGE RESOURCES MANAGAMENT

MEDICAL
Title PLACE ISSUED / NAME OF PHYSICIAN / INSTITUTE Date of issue Date expires
NATIONAL
PANAMANIAN
LIBERIAN

DRUG & ALCOHOL

YELLOW FEVER
CHOLERA

VISAS
Title Number Type Place issued Date of issue Date expires
AMERICAN
UK

Iva Shipping Ltd.

Date : Marasoviceva 67 Signature :
21 000 Split
http://www.iva-shipping.hr/ Croatia mailto:ivan.vodopivec@st.t-com.hr
 APPLICATION FORM F-100/10.02.
Page 4/5
UIN NAME RANK

Standard of NYK Shipmanagement

Shirts Trousers Overall Shoes

Item Size Unit

Helmet: cm
Neck: cm
Shoulders: cm
Chest: cm
Body: cm
Waist: cm
Sleeve outside: cm
Sleeve inside: cm
Leg outside: cm
Leg inside: cm
Safety shoes #: EU #
Safety shoes cm: cm
Boiler suit: S,M,L,XL,XXL
Uniform summer: S,M,L,XL,XXL
Uniform winter S,M,L,XL,XXL
Trousers waist: cm
Height: cm
Weight: kg

For filling above tables pls check for correct figures in sheet 5 Uniform guide

Bank details

Bank
name &
address
SWIFT CODE
IBAN No.
Acc. #
Monthly allotment

Iva Shipping Ltd.

Date : Marasoviceva 67 Signature :
21 000 Split
http://www.iva-shipping.hr/ Croatia mailto:ivan.vodopivec@st.t-com.hr
 APPLICATION FORM F-100/10.02.
Page 5/5

UNIFORM MEASUREMENTS COMPARISION TABLE

Overall
waist size chest size
inches cm inches cm
S 28-29" 71 - 74 33 84
M 30-31" 76 - 79 36 91
L 32-34" 81 - 86 38 97
XL 34-36" 86 - 91 40 102
2XL 36-38" 91 - 97 42 107
3XL 38-40" 97 - 102 44 112
4XL 40-42" 102 - 107 46 117
5XL 42-44" 107 - 112 48 122

Shoes
Centimeter English size US size Paris DTS
23.5 3 4 36
24.5 4 5 37
25.5 5 6 38
26.0 6 7 39-40
27.0 7 8 41
28.0 8 9 42
29.5 9 10 43
30.0 10 11 44-45
30.5 11 12 46

Shirts Trousers
neck size inches cms waist size inches cm
S 14-1/2" 37 S 28-30" 71 - 76
M 15" 38 M 30-32" 76 - 81
L 16" 41 L 32-34" 81 - 86
XL 16-1/2" 42 XL 34-36" 86 - 91
XXL 17" 43 XXL 36-38" 91 - 97
XXXL 17-1/2" 44 XXXL 38-40" 97 - 102