REVISION 0 II.3.7.1.1.

CREW APPLICATION - BASIC DATA

Document Owner Managing Director ZCM / Fleet Personnel

POSITION APPLIED FOR / 2nd Master DATE OF APPLICATION 08.'5.2023

OPTION

PERSONAL DETAILS

SURNAME Gavric
GIVEN NAME Josip
DATE / PLACE OF BIRTH 07.07.1979, Doboj
NATIONALITY Croatian
INSERT PHOTO
MARITAL STATUS Married GENDER male
HEIGHT (cm) 178
WEIGHT (kg) 84
DATE OF AVAILABILITY 5/10/2023

CONTACT INFORMATION

HOME ADDRESS Trampov breg 20, Rijeka

LANDLINE PHONE n/a
MOBILE PHONE 385995352192
E-MAIL [email protected]
SKYPE ID
NEAREST AIRPORT Zagreb

NEXT OF KIN DETAILS (NOK)

RELATIONSHIP Wife
SURNAME Rogic Gavric
GIVEN NAME Mihaela
NOK ADDRESS Trampov breg 20, Rijeka
NOK CONTACT NUMBER 385915148334

PRE-SEA EDUCATION
NAME OF SCHOOL / ACADEMY QUALIFICATION / DEGREE FROM TO
Maritime University Rijeka BSC of Nautical Studies 9/1/1999 7/1/2002

TRAVEL DOCUMENTS

NAME OF DOCUMENT NUMBER PLACE OF ISSUE DATE OF ISSUE DATE OF EXPIRY

NATIONAL PASSPORT
NATIONAL SEAMANS BOOK
US C1/D VISA
MEDICAL REPORT
YELLOW FEVER VACCINATION

CERTIFICATES

NAME OF DOCUMENT CAPACITY DATE OF ISSUE DATE OF EXPIRY

COC Master Unlimited 3/3/2021 3/3/2026
ENDORSEMENT
GMDSS / GOC 9/18/2020 9/18/2025

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 REVISION 0 II.3.7.1.1. CREW APPLICATION - BASIC DATA
Document Owner Managing Director ZCM / Fleet Personnel

POSITION APPLIED FOR / 2nd Master DATE OF APPLICATION 08.'5.2023

OPTION

IMO CERTIFICATES

NAME OF DOCUMENT NUMBER PLACE OF ISSUE DATE OF ISSUE DATE OF EXPIRY

ADVANCED FIRE FIGHTING 400485208 Rijeka 9/25/2020 9/25/2025
BASIC SAFETY TRAINING 400485222 Rijeka 9/25/2020 9/25/2025
ECDIS NMMSEG112 Glasgow 3/14/2014 n/a
BRIDGE TEAM & RESOURCE MANAGEMENT CTSBTM1005 Glasgow 10/5/2018 N/A

HUMAN ELEMENT, LEADERSHIP & MANAGEMENT (HELM) NMMSGMRM002 Glasgow 7/29/2016 N/A

ENGINE TEAM & RESOURCE MANAGEMENT

MEDICAL CARE 400556655 Rijeka 6/13/2022 6/13/2027
PROFICIENCY IN SURVIVAL CRAFT 400490026 Rijeka 10/5/2020 10/5/2025
SECURITY AWARENESS

SECURITY WITH DESIGNATED SECURITY DUTIES

SHIP SECURITY OFFICER 400005462 Rijeka 4/14/2009 N/A

SHIPBOARD SAFETY OFFICER (SBSO)
TANKER FAMILIARIZATION 400484978 Rijeka 9/18/2020 9/18/2025
ADVANCED TRAINING FOR OIL TANKER CARGO OPERATION 400508492 Rijeka 3/17/2021 3/17/2026
ADVANCED TRAINING FOR CHEMICAL TANKER CARGO 400485274 Rijeka 9/29/2020 9/29/2025
OPERATION

OTHER CERTIFICATES (EXCEPT MANDATORY AS PER STCW)

NAME OF THE DOCUMENT PLACE OF ISSUE DATE OF ISSUE DATE OF EXPIRY

HAZMAT(Acc US CFR)
RO-RO PASSENGER SHIPS
MAN ELECTRONIC INJECTED ME
SULZER RT FLEX
HIGH VOLTAGE / MEDIUM VOLTAGE
ECDIS TYPE SPECIFIC 1 UK 6/1/2017 N/A
ECDIS TYPE SPECIFIC 2 SAFEBRIDGE 5/20/2021 N/A
INCIDENT INVESTIGATION COURSE

OTHER QUALIFICATIONS AND SHORE BASED EMPLOYMENT

DECLARATION – applicable for Filipino nationality only

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 REVISION 0 II.3.7.1.1. CREW APPLICATION - BASIC DATA
Document Owner Managing Director ZCM / Fleet Personnel

POSITION APPLIED FOR / 2nd Master DATE OF APPLICATION 08.'5.2023

OPTION

I certify that the above information and attached sea service record are true and accurate; and that any false information would lead to the nullity and denial of this application.
That all Certificates of Competence or Licenses presented have never been revoked and/or suspended.

I agree that during this application process, I will be subjected to a computer based Professional and English Language assessment test. The results of which form part of this
application. I agree that previous employers may be contacted for information concerning my employment record and hereby release them from any liability and confidentiality in
providing such information.

In compliance with the Data Privacy Act of 2012 (RA 10173), I agree that ALL information regarding myself may be shared for hiring / processing and documentation purposes with
the principal and all internal interested parties, Philippine Government Agencies (e.g. POEA, OWWA, DFA, MARINA, SSS) and other external interested parties (e.g. AMOSUP, P&I
Clubs and Correspondents, HMO, Flag State Authorities, Medical Assessment and Diagnostic Centers).

DATE 11/27/2023
PRINT NAME + SIGNATURE

ZEACARE RELATED DOCUMENTS

DOC No. DOCUMENT NAME

II.2.7.1. Crew Screening

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 REVISION 0 II.3.7.1.1. CREW APPLICATION - SEA SERVICE
Document Owner Managing Director ZCM / Fleet Personnel

MANAGER OWNER RANK VESSEL NAME FLAG TYPE OF VESSEL DWT GRT M.E. TYPE M.E. PS/KW NO. OF CARGO SIGN ON * SIGN OFF NO. OF SIGN OFF
(MAKER) CRANES (dd/mm/yy) (dd/mm/yy) MONTHS REASON
NORTHERN MARINE MANAGEMENT STENA PROMAN MASTER STENA PROSPEROUS CYPRUS CHEMICAL TANK 49988 29884 MAN 7600 1 3/14/2023 4/20/2023 1 End of contract
NORTHERN MARINE MANAGEMENT NAVIGATOR GAS MASTER NAVIGATOR GLOBAL INDONESIA LPG TANKER 25000 16822 MAN 7000 1 10/18/2022 11/12/2022 1 End of contract
NORTHERN MARINE MANAGEMENT NAVIGATOR GAS MASTER NAVIGATOR GLOBAL INDONESIA LPG TANKER 25000 16822 MAN 7000 1 8/2/2022 10/13/2022 2 End of contract
NORTHERN MARINE MANAGEMENT STENA BULK MASTER STENA PREMIUM BERMUDA OIL/CHEMICAL T 65125 36168 MAN 2X7860 2 1/12/2022 4/6/2022 3 End of contract
NORTHERN MARINE MANAGEMENT STENA BULK MASTER STENA CONQUEROR BERMUDA OIL/CHEMICAL T 48769 27512 MAN 8580 1 5/23/2021 8/27/2021 3 End of contract
NORTHERN MARINE MANAGEMENT STENA BULK MASTER STENA PRIMORSK BERMUDA OIL/CHEMICAL T 65125 36168 MAN 2X7860 2 10/22/2020 1/18/2021 3 End of contract
NORTHERN MARINE MANAGEMENT STENA BULK MASTER STENA PRIMORSK BERMUDA OIL/CHEMICAL T 65125 36168 MAN 2X7860 2 2/27/2020 7/13/2020 4 End of contract
NORTHERN MARINE MANAGEMENT STENA BULK MASTER STENA PRIMORSK BERMUDA OIL/CHEMICAL T 65125 36168 MAN 2X7860 2 9/8/2019 12/1/2019 3 End of contract
NORTHERN MARINE MANAGEMENT STENA BULK MASTER STENA PROVENCE BERMUDA OIL/CHEMICAL T 65125 36168 MAN 2X7860 2 3/7/2019 3/25/2019 1 End of contract
NORTHERN MARINE MANAGEMENT STENA BULK MASTER STENA PROVENCE BERMUDA OIL/CHEMICAL T 65125 36168 MAN 2X7860 2 10/14/2018 1/31/2019 3 End of contract
NORTHERN MARINE MANAGEMENT STENA BULK MASTER STENA PROVENCE BERMUDA OIL/CHEMICAL T 65125 36168 MAN 2X7860 2 4/20/2018 7/18/2018 3 End of contract

* list all sea service incl. cadet ship

ZEACARE RELATED DOCUMENTS

DOC No. DOCUMENT NAME

II.2.7.1. Crew Screening