Elegant Marine Services Private Limited (LIC No.

RPSL-Mum-172)
(Agents of Fleet Management Ltd.)
Our Principal’s Website : www.fleetship.com

Application Form / Personnel Data Update Form

Post applied for : Willing to accept lower rank ? Yes No Available From : / /

(A) PERSONAL PARTICULARS (AS IN PASSPORT)

First Name HAKAN Middle Name Last Name/Surname DEMIRCI

Nationality TURKISH Date of Birth 25.05.1977 Place of Birth VAKFIKEBIR

Height 180 Weight (In KGS) 105 Smoker / Nonsmoker Yellow Fever Union Membership
(In CMS) Blood Group 0 (+) Veg. / Non - Veg. DOI DOE BATCH /LOT No.
YES NO
Boiler Suit Size : MED / LARGE / XL / XXL Shoe Size : 44 19.09.2018 N/A N3A04
Permanent Address : Present Address :
Aydogdu Mh. 1267. Sk. Oyak Sitesi 2E1 Blok No: 54 Same as mentioned
City : BUCA Tel. : +905304199440 City : BUCA Tel. : +905304199440
Post Code : 35395 Mobile : +905304199440 Post Code : 35395 Mobile : +905304199440
E-mail : hakankpt@gmail.com Nearest Airport : ADB (IZMIR)

Document No. Date of Issue Place of Issue Date of Expiry

DD/ MM / DD/ MM/ YY
YY
Passport : Country 14886670 23.08.2017 BUCA 23.08.2027
Seaman’s Book (CDC) : National S00149651 25.05.2015 ANKARA 25.05.2020
Seaman’s Book (CDC) : Liberian
Seaman’s Book (CDC) : Panamanian
Seaman’s Book (CDC) : Marshall Island
Other (CDC) :
Valid US Visa “C1/D” Yes / No Date of Expiry : Passport ECNR : Yes / No
Australian Maritime Crew Visa Yes / No Date of Expiry :

Next of kin : ADILE CAN DEMIRCI Relationship : SPOUSE DOB : 30.01.1977

Alternate next of kin : AYSE CAN

(in case of family joining) Relationship : MOTHER IN LAW
Address : YAYLACIK MH. GOP. CAD. NO : 36 KAT : 2 BUCA - IZMIR / TURKEY
Tel. : +905417232253
....................Family Data....................
Relationship First Name Last Name DOB Passport No. Place Issued Valid until
Spouse ADILE CAN DEMIRCI 30.01.1977 U10393130 BUCA 30.12.2024
Child M / F ADNAN FURKAN DEMIRCI 17.03.2007 U10393033 BUCA 30.12.2019
Child M / F EMIN FATIH DEMIRCI 17.06.2010 U10393031 BUCA 30.12.2019

Indicate Type of Valid Visa : USA CANADA BRAZIL UK OTHERS

*Anniversary Date : 02.03.2003 TURKEY

* Please check if visa and all documents are valid for the tenure on board, plus 6 months.
FORM NO : EMSPL / 02 / 2013
REV. NO : 02 / 2016

[ 1 / 10 ]

Applicant’s Signature
 (B) Education / Other Qualifications :
EDUCATIONAL QUALIFICATION
Result Grade (1st, 2nd,
10 + 2 / Degree Institution / University Year of Passing 3rd or A, B, C etc)

Bachelor of Nautical Science Maritime Business&Manag./9 Eylul University 2005 3,`99 (5)
PRE - SEA TRAINING / APPRENTICESHIP / MARINE ENGINEERING / NAUTICAL DEGREE OR DIPLOMA
Result Grade (1st, 2nd,
Pre - Sea Training Training Institution / Company Name From - To 3rd or A, B, C etc)

STCW Trainings Marine Training Center / ITU Maritime Faculty 1998-2000 SATISFACTORY
BRM & ECDIS 9 Eylul University Maritime Faculty 2000-2005 SATISFACTORY
CERTIFICATES OF COMPETENCY :
Highest Competency Certificate Held
Date of Passing Examination
Issuing Authority Grade Certificate No. DOI Place Issued Valid until
National (TURKEY) O.G. MASTER G15157 27.06.2018 ANKARA 27.06.2023
National (TURKEY) MARINE PILOT 10398847 09.03.2016 ANKARA 09.03.2021
National (TURKEY) MARINE PILOT 10503543 24.07.2018 ANKARA 24.07.2023
National (TURKEY) YACHT MASTER 10517560 24.12.2018 ANKARA 24.12.2023
GMDSS GOC T10904 25.05.2015 ANKARA 25.05.2020
LIST OF S.T.C.W. 1995/2010 OTHER COURSES DONE
Courses Cert. No. 95 Cert. No. 2010 Date of Issue Date of Expiry
1) FPFF / Advanced Fire Fighting 10410600 25.05.2015 25.05.2020
2) Proficiency in Survival Craft & RB / PST 10410598 25.05.2015 25.05.2020
3) Elementary / Medical First Aid / Medicare 10410602 25.05.2015 25.05.2020
4) PSSR 10410601 25.05.2015 25.05.2020
5) CTFC / CHEMCO
6) OTFC / TASCO
7) GTFC / GASCO
Applicant’ [2
8) Personal Survival Techniques Training 10410599 25.05.2015 25.05.2020
9) Ship Manouvering Simulator Course 26.03.2018 30.03.2018
10) Radar Observer Course / ARPA 11094198 20.12.2018
11) Radar Simulator Course / RANSCO 11094198 20.12.2018
12) BTM / BRM 11094197 20.12.2018
13) ISPS (SSO / STSDSD) Course 10605888 19.07.2016 19.07.2021
14) NIS Familiarisation Course
15) C.O.C. Revalidation Course G15157 27.06.2018 27.06.2023
16) F i r e P r e v e n t i o n & F i r e F i g h t i n g T r a . 10410603 25.05.2015 25.05.2020
17) ECDIS General / Type Specific
18) Training and Qual.of Personnel on Passg. 10410604 25.05.2015 25.05.2020
19) Medical First Aid Training 11094196 20.12.2018
20) Medical Care Training 11094200 20.12.2018
21) Security-Related Training 11094195 20.12.2018
22) Designated Security Duties 11094192 20.12.2018
23) Security Awareness 11094194 20.12.2018
19) ECDIS(Electronic Chart Display Inf. Sys.) 11094193 20.12.2018
Dangerous Cargo Certification :
1. Endorsement on NATIONAL Certificate Level Number DOI Place Issued Valid Until
Petroleum
Liquified Gas
Liquid Chemicals
2. Other Endorsements
 (C) SEA SERVICE : (Start From Last Vessel Served)
Flag of Type of Engine make & model & BHP/KW (For DWT (D) From To Total
Name of the Company Name of the Vessel Engineers) Rank
[ Vessel Vessel Cargoes Carried (For Deck Officers) GRT (G) dd/mm/yy dd/mm/yy M/D
3
Non Fleet Management Vessels
HATAY RORO LINE HABIB NECCAR COMOROS RORO/FERRY 8619 GRT MASTER 04.07.2018 12.10.2018 3 M 10 D
CENK SHIPPING CENK A TURKEY RORO/FERRY 8728 GRT MASTER 28.02.2017 24.07.2017 4 M 29 D
HATAY RORO LINE HABIB NECCAR COMOROS RORO/FERRY 8619 GRT MASTER 07.09.2017 02.11.2017 1 M 26 D
Applicant’s
SIMA SIPPING AZOV PALAU RORO/FERRY 8485 GRT MASTER 25.07.2016 10.10.2016 2 M 17 D
MSC SHIPPING MSC SEBNEM TURKEY CONTAINER 8908 GRT 2ND OFF 18.05.2004 30.09.2004 4 M 13 D
TURKON LINE TURKEY CONTAINER
SELMA KALKAVAN 12171 DWT 2ND OFF 16.04.2003 06.09.2003 4 M 14 D
TURKON LINE TURKEY CONTAINER
ALKIN KALKAVAN 12238 DWT 2ND OFF 16.01.2003 23.02.2003 1 M 7 D
TURKONLINE TURKEY CONTAINER
BESIRE KALKAVAN 12238 DWT 2ND OFF 18.06.2002 17.11.2002 5 M 1 D
TURKON LINE MUKADDES KALKAVAN TURKEY CONTAINER 12204 DWT 2ND OFF 31.05.2001 14.08.2001 3 M 15 D
MARDENIZ SHIPPING HATIME ANA TURKEY BULK CARRIER 20510 GRT 3RD OFF 22.08.2000 11.03.2001 6 M 13 D

Remarks : 21.07.2015-22.01.2016 MARINE PILOT (PETKIM PETRO-CHEMICAL PORT FACILITY), 29.01.2018-26.06.2018 MARINE PILOT (ULUSOY CESME PORT
FACILITY), 2006-2011 PORT&FLAG STATE CONTROL OFFICER (MED MOU) and MARITIME TECHNICAL ASSIGNEE (REPUBLIC OF TURKEY, MINISTRY
OF TRANSPORT)

Sea Service with Fleet Management Vessels

UN RORO (DFDS) UN PENDIK TURKEY RORO 29004GRT MASTER 30.04.2015 16.07.2015 3 M 17 D
UN RORO (DFDS) UN TRIESTE TURKEY RORO 29004GRT MASTER 04.03.2015 04.04.2015 1 M 1 D
UN RORO (DFDS) UN KARADENIZ TURKEY RORO 29004GRT MASTER 09.07.2014 01.03.2015 4 M 24 D
UN RORO (DFDS) UN PENDIK TURKEY RORO 29004GRT MASTER 30.05.2014 03.07.2014 1 M 4 D
UN RORO (DFDS) UND EGE TURKEY RORO 26469GRT MASTER 26.03.2014 22.04.2014 0 M 27 D
UN RORO (DFDS) UN AKDENIZ TURKEY RORO 29004GRT MASTER 19.01.2014 20.03.2014 2 M 2 D
UN RORO (DFDS) CUNEYT SOLAKOGLU TURKEY RORO 29004GRT MASTER 05.11.2013 13.01.2014 2 M 8 D
UN RORO (DFDS) CEMIL BAYULGEN TURKEY RORO 29004GRT MASTER 04.08.2013 01.10.2013 1 M 25 D
UN RORO (DFDS) SAFFET ULUSOY TURKEY RORO 29004GRT CHF. OFF 18.08.2012 30.01.2012 5 M 16 D
UN RORO (DFDS) UND ATILIM TURKEY RORO 26469GRT CHF. OFF 07.04.2012 09.08.2012 4 M 1 D
(D) Experience Matrix of Engineer Officer
Please mark ‘Y’ against your rank in the cell, if that experience is applicable to you
S.No. Crane Make C/E 2/E 3/E 4/E E/O Any Breakdown experience / Remarks
Experience on Deck / Cargo Machinery
1 Haaglund
2 Liebherr
3 IHI
4 Mitsubishi
5 NMF
6 Atlas
7 BLM
8 MacGregor
9 Any Other
Grab Make
1 SMAG Peiner
2 ORTS
Experience on Reefer Machinery / Reefer Container
1 Direct System
2 Indirect System
3 Carrier Transicold
4 Thermoking
5 Daikin
6 Mistubishi
7 Any Other
Experience on Oil / Chemical / Gas Tankers
1 Framo Pumps
2 Centrilina Pumps
3 Steam Turbines
4 Any Other
Experience on Propulsion System / Manoeuvering System
1 CPP
2 Bow/Stern thruster
3 Twin Screw
4 NOR Control
5 Kongsberg
6 Any Other
Experience on Auxilliary Engines
1 Yanmar
2 Daihatsu
3 Sulzer
4 MAN B&W
5 Cummins
6 Caterpillar
7 Pielstik
8 Volvo Penta
9 Any Other
 S.No. Crane Make C/E 2/E 3/E 4/E E/O Any Breakdown experience / Remarks
Experience of major overhaul / breakdown
1 Drydock
2 M/E Turbocharger
3 M/E Governer
4 M/E Cyl. Liner
5 Thrust Block
6 A/E Crankshaft
7 Alternator overhaul
8 Steering Gear
9 Any Other
Experience in Disaster Management
1 Grounding
2 Collision
3 Oil Spill
4 Crank Case Explosion
5 Scavenge Fire
6 Engine Room Fire
7 Cargo Fire
8 Abandon Ship
9 Steering Failure
10 Any Other
Experience in PMS
1 AMOS
2 TM Master
Additional Comments to Explain above

Applicant’s Signature
(E) Experience Matrix of Deck Officer
Please mark ‘Y’ against your rank in the cell, if that experience is applicable to you
S.No. Description M CO 2O 3O Cdt Any Breakdown or incident experience /
Remarks
Have you sailed in the following areas ?
1 Indian Ocean x x x
2 Pacific Ocean
3 North Atlantic Ocean x x x
4 South Atlantic Ocean
5 South China Sea x x x
6 Australian Waters
7 Mediterranean Sea x x x x x
8 Black Sea x x x x x
9 English Channel / North Sea x x x x
10 Singapore Straits x x x
11 Panama Canal
12 Suez Canal x x x x x
13 Kiel Canal
14 Great Lakes
15
16
17
Chemical / Product Tanker Tank Cleaning experience
1 Cleaned tanks after carriage of veg. oil ?
2 Cleaned tanks for Methanol carriage ?
3 Cleaned tanks MEG or similar cargoes ?
4 Cleaned tanks for Veg Oil carriage ?
5 Cleaned tanks for Jet Fuel ?
6 Changed from dirty to clean products ?

Gas Tanker Experience

1 Fully Refrigerated vessel
2 Fully pressurised vessel
3 Partially refrigerated vessel

Oil / Product / Chemical Tanker Experience

1 Inert Gas vessel
2 Crude Oil Washing
3 Inert Gas purging
4 Cleaning crude oil tanks for hot work
5 Framo Pumps operation
6 Cargo Heating
7 Framo Pump damage
8 Over / Under pressurization of tanks
9 Cargo contamination
 S.No. Description M CO 2O 3O Cdt Any Breakdown or incident experience/
Remarks
Bulk Carrier Experience
1 Hose test for hatch covers x x x
2 Bilge valve testing x x x
3 Ballasting of cargo hold x x x
4 Disposal of cargo residues x x x
5 Draft survey cargo calculations x x x
6 Over / Under pressurization of Holds
7 Cleaned Holds for Grain carriage ? x x x
8 Cleaned Holds for Fertilizer carriage ?

Experience of major overhaul / breakdown

1 Drydock x x x x x
2 Windlass damage / Loss of Anchor
3 Sterring Gear failure x x x x x

Experience of Special circumstances & Disaster Management

1 Grounding
2 Collision x x x
3 Oil Spill x x
4 Crank Case Explosion
5 Scavenge Fire
6 Engine Room Fire
7 Cargo Fire
8 Abandon Ship
9 Steering Failure x x x x x
10 Freezing Weather
11 Heavy weather / TRS x x x x x
12 Fog / Restricted visibility x x x x x

Experience in PMS
1 AMOS x x x
2 TM Master x x x
Additional Comments to Explain above

Applicant’s Signature
 (F) GENERAL :
(1) Have you ever been denied a foreign visa or been deported from any country ? Yes / No
If yes, state which country and reason (if known) : x
(2) Have you been the subject of a court of enquiry or involved in a maritime accident ? Yes / No
If yes, please attach details x
(Collision, Grounding, Fire, Pollution)
(3) Have you ever signed off a ship due to medical reason within last 3 years ? Yes / No
If yes, please provide following details : x

Name of vessel
(4) Have you ever been involved in any criminal activity or have pending criminal case ? Yes / No
If yes, please provide details
______________________________________________________________________________________________
______________________________________________________________________________________________
(5) Have you ever been involved in any navigational incidents in last 24 months ? Yes / No
If yes, please provide details

______________________________________________________________________________________________
(6) Are you currently under medical treatment or taking medication for existing conditions ? Yes / No
If yes, please provide details
Comments on above ____________________________________________________________________________
______________________________________________________________________________________________
(7) Last drawn salary in USD : 5500
Please provide copy of your Account of wages.
(8) References
Please give referees from two recent employers who we may contact for references
Reference 1 Reference 2
Name of Company UN RORO (DFDS) ULUSOY CESME PORT FACILITY
Name of Person to contact BULENT CIHANGIROGLU(DPA) OZGUR ALTINKAYA (PORT MNG.)
Address ISTANBUL CESME PORT, IZMIR

Country TURKEY TURKEY

Telephone +905324221243 +905555595821
I Do hereby declare that all information furnished is true to best of my knowledge and belief.

Received acknowledgement of Application form

Date : 04.01.2019 Rank : MASTER Applicant’s Signature

(G) FOR OFFICE USE ONLY

Elegant Marine Services Private Limited. (LIC No. RPSL-Mum-172)

(Agents of Fleet Management Ltd.)
Our Principal’s Website : www.fleetship.com

SHIP’S STAFF INTERVIEW FORM

STAGE I

Name of Candidate : HAKAN DEMIRCI Date :

Rank Applied For : MASTER Location of Interview : ISTANBUL

Interview Method (Physical / Telephone / Video Conference) :

This form shall be used to document the observations made during the interview. The interviewer may provide
his recommendations for additional training if required.

For items marked ‘Poor’. Please give your comments.

A. Appearance / Character V.GOOD GOOD S’FACTORY POOR N/A

1 Dress
2 Grooming
3 Body language
4 Communication skills

Comments if any :

B. Professional knowledge V.GOOD GOOD S’FACTORY POOR N/A

1. Navigation and Watch keeping

2. Cargo work
3. Technical Knowledge
4. Safety awareness
5. Engineering Knowledge
6. Awareness of regulations

Comments if any : (

Result of Interview : Suitable / Not suitable for employment

Suitable For Vessel Type : Rank :

Interviewed By Name Signature

(H) FOR OFFICE USE ONLY

STAGE II (Checked by : Personnel Officer) Name : Sign

Documentation checks
a) Copies of all STCW certificates received ? Yes / No
b) Copy of all valid Certificates of Competency including Endorsements received ? Yes / No
c) Copy of National or Main Certificate of Competency verification certificate received ? Yes / No
d) Copies of Passport including all valid visas received ? Yes / No
e) Copies of Seaman’s Book including all pages containing sea service received ? Yes / No
f) Copies of Vaccination Book received ? Yes / No
Comments regarding non-receipts :

STAGE III (Assessed By : Superintendent / Manager / Sr. Manager / D.G.M. / G.M.)

Name : Sign

Comments :

Regd. Office : Elegant Marine Services Private Limited :602, The Great Eastern Galleria, Sector-4, Nerul, Navi Mumbai- 400 706
CorporateOffice : Elegant Marine Services Private Limited : 601/A, Elegant Business Park, Off Andheri Kurla
Road, Near Kohinoor Continental Hotel, Andheri (E), Mumbai - 400 059. India
Tel. : (+91 22) 3090 6100 z Fax : (+91 22) 3090 6200 z E-mail : seacareer@elegantship.com
Branch Offices : DELHI : Tel. (0124) 469 0400 z KOLKATA : Tel. (033) 4006 1030 Fax (033) 4006 1039
KOCHI : Tel. (0484) 406 3666 Fax (0484) 406 3665 z CHENNAI : Tel. (044) 2431 4744 Fax (044) 2431 4746
VIZAG : Tel. (0891) 274 9775 Fax (0891) 271 9775 z PATNA : Tel. (0612) 220 6788 Fax (0612) 220 6792
LUCKNOW : Tel. (0522) 402 4685, 402 4686, 407 6494 z CHANDIGARH : Tel. (0172) 464 7015