1. SURNAME : Kolyva Chios, Greece
FIRST NAME : Eirini MOBILE:
MIDDLE NAME : Vasileia TELEPHONE:
FATHER’S NAME : Stavros NATIONALITY:
MOTHER’S NAME: Markella EDUCATION :
MARITAL STATUS: Single EMAIL :
BIRTH DATE : 01-March-1994 BIRTH PLACE :
HEIGHT : 159 CM WEIGHT:
DOCUMENT NUMBER DATE ISSUED VALID UNTIL
PLACE ISSUED /
AUTHORITY
SEAMAN’S BOOK TH' 24995 14/2/2013 unlimited CHIOS
PASSPORT AK1006516 27/12/2012 26/12/2017 CHIOS/N.P.C.
IDENTITY CARD AZ933228 7/2/2009 CHIOS
60 KG
Merchant Marine Academy graduate
Chios, Greece
eirinikolyva@gmail.com
Hellenic
RANK: Second Officer
CREW APPLICATION FORM
PHOTO
PERMANENT ADDRESS:
+30 2271078954
+30 6987219289
IDENTITY CARD AZ933228 7/2/2009 CHIOS
USA VISA C9239996 / C1/D 4/3/2013 28/2/2023 ATHENS
CYPRUS SEAMAN
BOOK
CY205788 3/4/2013 2/4/2023 PIRAEUS
MARSHALL ISLAND
SEAMAN BOOK MH382887 12/11/2014 11/11/2019 PIRAEUS
LICENSES NUMBER DATE ISSUED VALID UNTIL
PLACE ISSUED /
AUTHORITY
CAPTAIN CLASS C 0111035 15/11/2016 15/11/2021 PIRAEUS
CERTIFICATES NUMBER DATE ISSUED VALID UNTIL
PLACE ISSUED /
AUTHORITY
BASIC TRAINING 20091 13/3/2014 12/3/2019
PROFICIENCY IN
SURVIVAL
20091 6/5/2015 23/3/2020
RESCUE BOATS 20091 6/5/2015 2/4/2020
MEDICAL CARE 20091 6/5/2015 29/4/2020
G.M.D.S.S. (G.O.) GM00011516 15/6/2016 14/6/2021
SSO SSO00054916 10/11/2016 9/11/2021
ECDIS ECD00082516 29/11/2016 28/11/2021
RO-RO 122 1/7/2016 7/7/2021
HELLENIC COAST
GUARD
PROFICIENCY IN
ENGLISH
27/11/2010 unlimited
USA/ UNIVERSITY OF
MICHIGAN
NEA MICHANIONA/
NATIONAL SCHOOL OF
LIFE SAVING AND FIRE
FIGHTING APPLIANCES
COSMOS NAUTICAL
TRAINING CENTER

2. RANK SIGNED ON
SIGNED
OFF
CAUSE OF
DISCHARGE
VESSEL’S
NAME
VESSEL’S
TYPE
FLAG D W T COMPANY
DECK CADET 24/3/2013 9/9/2013 M.C. NORFOLK B.C CYPRUS 85957 DIANA SHIPPING
APPR. OFFICER 16/10/2014 6/2/2015 M.C. ALCMENE B.C MARSHALL 51255 DIANA SHIPPING
APPR. OFFICER 13/8/2015 21/9/2015 M.C. ARTEMIS PASSENGER GREEK 1612 HELLENIC SEAWAYS
APPR. OFFICER 25/6/2016 16/8/2016 M.C.
NISSOS
MYKONOS
PASSENGER GREEK 8129 HELLENIC SEAWAYS
PREVIOUS SEA SERVICE