Seafarer’s application form

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Personal Information

Personal Information

Поля, обязательные для заполнения *

Date of birth *
Maritial status

Present address

Background Education

Date

Personal Documents

Personal Information
Number
Date Issued
Place Issued
Exp. Date
Seaman's Identification Card
Tourist passport
Certificate of Competence
National Endorsement
USA Visa
Schengen Visa

Sea-service at last 5 year

Sea-service at last 5 year (from first to latest) *

Vessel's Name
Master's Surname
Type of Vessel
DWT
Cargo gear
Load/Crane Type
Flag
Company's Name & Country
Rank
Period (From-To)
(dd.mm.yyyy)

By filling out this questionnaire and submitting it in any way to the maritime agency “Univis, Ltd”, the applicant hereby gives his consent, in accordance with the Law of Ukraine “On Personal Data Protection” No. 2297-VI, to the inclusion of his personal data in the PDB “CLIENTS” of LLC “UNIVIS, LTD” in the form of files and/or automated information system, as well as for their processing (collection, registration, accumulation, indefinite storage, modification, depersonalization, destruction, updating, adaptation, use, distribution, realization, transfer in full or in part to the managers or third parties) without additional written notice to the enterprise, in order to provide the enterprise with intermediary services for its employment on the ships of domestic or foreign shipowners, regardless of their country of location.

I am notified in writing about the inclusion of my personal data in the PDB “CLIENTS” of LLC “UNIVIS, LTD”, about its location and purpose of data collection, about the persons to whom my personal data will be transferred.
I am also aware of my rights regarding my personal data, such as: the right to access, modify, delete or revoke consent (LAW OF UKRAINE “On Personal Data Protection”).

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