2. Pnlfcclion Iccnrrl' Ie pcludhml
1.0 paludilmo, une malad!.: grave parfoit martelle, &evil
IIIICOre. liotat endemiquc: dans un tret if8Dd n(lmbre de paY'
tropicaux.et lubtropicaux. Vous ne pouvez pas etre vaccine
colltre Ie paludlsme, maiic VOlll pouvcz VOilll proleger contre
letspiqwel demousUqucl (usagedemoUlitiquBries, rcpulsifs).
En outre, lell mcdicnmeDta antipaludiques peuvent ctre
uti.le., soil pries n:guliaemcnl a lite prcventif soit tenus en
reserve .pour Ie IrBitemcnt d'urgence d'unc fiewl:'·en l'absence
de spins medicllWl. I..e risque d'infection et III response des
pBDliutes aux medicaments sont varioblc:s el changeants.
CollCcnumt l'utilisBtion de med1caments antipatudiques
specia1iBee la plus ptbche, ou encore la deD1lere edition de la
brochuxe de rOMS Certlffjcacs de vaccination exigeJ et
conetlsd'hygienepourles voyagumternatiorumx,
Si VOllS prencz des medicaments antipaiudiques a titre
proventif. it est nccessaire deles prendre de fiu:on 8bsolument
reguliere, derefcnmce pendant ou immcdiatement apm un
rcpBB plutot qu'll jeun, de cODlIJleIlcer un,c aemaine avant Ie
depart verse Ie pays au Ja regina impaiude9. et continuer
pendan1les six semtamc:ssuivantleretoW'.
Aucune.me thode De puel gSJ'llDt:irune protection complete.
Si uno fievre Be declare emre UIKl sems.mc apTeS Is premiere
c:xpositionetjusqu'a dcuxans apres votreIetoW' ne manquczpas
decorurultervollemedecin ct de rinformerde votre aejourdans
uneregionimpaludee,
Qi'Oi'..,
!~'--.I
~~
00
j::j::
~~
~~
~~
-.I~
ifi :! '
:t~
~ ~
:Z: ""
g~
~;:
a: ~
~ (!)
! :t!
FI!:UERAL REPUBLIC 01, •...:!(a.:ru.
INTERNATIO"AL CERTn:ICTE
OF VACCINATION
CERT1FICAf INTI:RlATIO;",AL
DE VACCINATION
T5>IIl'tllo } a;-.., L / r-r-ZDelima ~)lJ A~ A ·A
Pa~5porr No
or
tnnd Dotum.1II '1,0
Num.ro du pD5~llorl fADQ bCO Qb 5 Q
IIU
d.la pl~c.jlllttl(1C11lhc I)
3.
4. FEDERAL REPUBLIC OF NIGERIA
[J)207 001521
NIGERIAN MARITIME ADMINISTRATION AND SAFETY AGENCY
SEAFARERS MEDICAL CERTIFICATE
surname:..A.g.1?~.I.hA..;;?~E.~therNames....f..~.~.!~.t':?f::f.t......:4S.H:.I.(Y."J
.DateofBirth:..~.I..l.q.L..l..~l.b.~..~okNo:....I±..~..~.~.~..Q..Q~.~
Department: Deck D Engi'(~~c::1cateringD OthersD
r.. I . ,' 11[ lr:1nsport ~
Remafk(s) ..............:.I...cfiN:RE...............
• l.. •
. 1
~ .. C· ..
s· " . " "'; .;; u. ....v.:..
• ,
~" ~ ..?.f ..... /;·. ·..·:·~~·.··~~~·t~~~..&·N·a·~~·~f·APp~~~~·M~·d·i~·aT~·~~~..........
SAFETY COPY (j1• . .••••• I . .
61gn ........ .• ... . . ..•••
Telcph nc (a~~~~~~~: ..···......·......·offi~i~i·Sta~p··............. .
I ....., :felpi)v ofthis certificate: .2:-:~.I.~.f.?:~ (S"'"
I certify that I have examined the se · re a.~b
FIT~~~l-tW:MIl~r~ '¥~&U ecttotbere
5. Established by Decree No. 16 of 1988
(NOW CAP 217 LAWS OF THE FEDERATION OF NIGERIA, 1990)
MANJAFF/NO...~?t.
,n . .... .~ ......,U'........".............. ...'.....-..,............---...........................~..-...~~.--..-.......--.............
having satisfactonly completeaat the Maritime Academy of Nigeria, Oron,
an approved course of training in Advanced Fire Fightrng in accordanqe witti
the competence specifications of Table A- VI/3 of the STCW Code a'od,the
provision of the STeW Convention.
g.wm __ .............. .-.. ~ ""]II" - ~~
!l)ated ~ , .:' .AM'"' dcuJ 4.. ..-,..... , I
....
":~'n',
~'"'
6. MARITIME ACADEMY OF NIGERIA, ORON
(c9M,aJl-i6luut~@ec~~.Ar(){ -16 oJ~98~
MAN! MFA/NO:~tf1!'.U
t'r-~r--=-==;;;=="'i'1 11 ......'"
K~ijij'-~£ ...."1'0 ...UlV,
FIRST AJDCERT,IFIC~··
having satisfactorily completed at the Maritime Academy of Nigeria,
Oron, an approved education and training in Medical First Aid
in accoro3nce with the competence specifications of Table
A-VI/4-1 of the ~cw Code and the provisions of the ~CW Convention.
5~~t~~··~.&.t~,·4.!..u
.=.:::::'ii-~.~:.~~.:::::'&~'<h'U~::~~~:~~:~.
7. Wate ofrBirtfz:.....~I....4"'~~.!!'f!'.1'.:~..', ......~".• :.........
:Nationafity:.L...;...&!:f~r'~..........................
Hawing ~atfsfaGtorHy completed an approved course of training in international
Safety, manag~h1e.nt (ISM) CQd~ in accordance with the requirements ofChapter I
IIX of the Internatiooal Cor;v~-1ention for the Safety,of Ufs"atSea (SOlAS) 1974, at
tbe MaritimeAcade.my ofNigerla, Orpn.
,Nt .... ... . p .. .
//". ,.ram. "".;, "", ",/i,/ "';/1",,,,//,.. /, '"/"11/1" 01111111/ ..',11 I', ;111.',/" 1,II" ('''''''1'111/11'111/'";11/,.,, / I'll,
9. ,,1_1abltshed"in 1977 anauYBratfetf6'1 Decree :No. 16 of1988
(NOW CAP 217 LAWS OF THE FEDERATION OF NIGERIA 1990)
MAN/PSCRB/NO., s i
• ~ ,f"
f
Ii
Name:.........
~~............~
Date of Birth:............~.1':.~.~r.,-.
Nationality:.........................~........
Having satisfactorily completed at the Maritime Academy of Nigeria, Oran, a
course of training in Proficiency in Survival Craft and Rescue Boats (other
than Fast Rescue Boats) in accordance with the competence specifications of
Table A-VII2-1 of the STCW Code and the provisions of the STCW
Convention as approved by the Nigerian Maritime Administration and Safety
Agency (NIMASA).
Registrar:
10. IOFFS
RIVERS STATE UNIV£RSIl'V OF SCLENCE AND TECHNOLDGY CAMPUS
PORT HARCOURT· NIGERIA. Website:www.charkinglOupcom
~ADI~)IOIA 4SDIIJ AQ))JJIAZE'~.~;
Has met the standard of competence
as specified in SECTION A-VIIl
TableA-VII1 -1 of.th'i~" Re~isecl STew (2010)
~CEO/MD
24TH MAR.! 2015
Dote of Issue
CMOSC Nt} 1 00176CEN T.
CHAIKINIIIUml1!&
RIVERS STATE UNIVERSITY OF SCIENCE AND TICHNflLOGY CAMPUS
PORTHARCOUR1· NIGERIA. Weksite:www.chllrkingrollll.cI..
e M 0 S C
""RrHARtalRT
CERTIFICATE OF PROFICIENCY IN
PERSONAL SAFETY
SO'Ci.IAL RE'SPONSI'BILITIE;S
llnl~)IOIA ilSIII)ll'lInIJlAZI~I~Z
Has met the standard of competence
as specified in SECTION A-VIIl, Table A-Vl/1-4
ofthe Revised STew (2010)
rW~ HOD
24TH MAR., 2015
Dote of Issue
C~PI~ N~ 100011
11. I~~ III
RIVERS STAff UNIVERSITY OF SCIENCE AND nCHNOLOGY CAMPUS
PORT HARCOURT · NIGERIA. Webite: www,charldIlAJOup.C
ELEMENTA
rrRAINING:
AJ)nIOIA ASBill All»']), t.t1~·4
Has successlully completed an Elementary First AI,
. "..Training Course at~t~e~~~t~in, Maritime Salety ~ntr. (Pott
Hareourt - Nigeria) in accordance with SECT~~N A-VIA1-!
"0'the Revised STCW Convention (19,5)
Admintstrator
c T
FIRE P~EVENTIO~ '"&_FIRE FIGH~ING
TRAINING CERTifiCATE
Has successfully Completed a
Fire PreventU;n~ Fire fighting. Train_ing-C6urse at'the
Charkin Maritime Safety Centre.(POrlHarcb~rt - Nigeria)
in accordance with SECTION A-VI/~-2
of the Revised STew COl"wenfion (1 ,, 95)
Administrator
5TH MAY, 2011
5TH MAY, 2011
Date of IssueDate of Issue
CMSC CMSC .N·~ 21135'('ERT. Nfl 311328 CERT.
12. We t African Examinations Council
~enera[ ([ertifi ate f ~bu(ation
OROl LEVEL
his is to <!Cerff tlJat:
/zaring been ill attelldance a1 the following Tee gllised school
o , l G
'laT the Join! ExaminaTion (or the School Certificate and
General erl(/icale of Education and obtained / !le r 1 IfliS
s/zo t n be/oil'.
(J ( J
ilt!)J "'I.BJE RI D J [ [I
J " LT
7
CD 1
u.
-
5 1 1
GSG 148518 B~--n
13. ..., .
NOTIFICATION OF RESULTTHE WEST AFRICAN EXAMINATIONS COUNCIL
:J L
...;;
.!:!
...
'"
~
.",
0
..~
0
.:
c;
...t:
~
~~
!!'
.....~
0
0
e
~
..
a Of SUe JEC TS Ll
INTERPRETATION OF GRADES
1 is a preliminary notification 01 result for Ulia by !tie candiaate to Whom it applies. and
does not represent a Certificate,
RS 104549 6c
•
14. , .-- ."
,
SEAFARERS REGISTRATION FORM
PDS: SURNAME: -f-r-~.f.:> t I_A --;L E L -/
RANK ALLiED FOR: LfT! F r /;Iv ( 1 r t<'lC£;:!. GIVEN NAME r~L i!'...}'I-- t
., .~- 1v
W1LLfNG TO ACCEPT LOWER RANK: iJO NATIONALITY: ~-) e,L ''- 11,)
PERSONAL DETAILS:
MAIUTAL S ATUS
.
RELIGION: i s L'1 i"
WEIGHT: gO ~6 HEIGHT: I . 68 ~f
DATE OF BIRTH 1.1 · Olr-- 6 C) PLACE or DIRTH: iFJi ~ r, t'-.
MOTHER'S LANGUAGE i vy..lr~f
OTHER LANGUAGES: k /,J (1" h.! C ,--
PARENTS MOTHER NAME:
PRESENT ADDRESS: ISA ~~AKt-)N ':"'...,-( I;{£ C"I K 0":..." -,~ [., ,.1 , L / c, '-,....:;:
PIlONE: D 8-0 ~1... -, ~ -:. =-- S 0 6,
NEXT OF UNS NAME AND ADDRESS: ly),,7~ M'"'I>J":::, L~ '7 -= f.. ...,, , ~ ' l ,~ t:. ,~ .... tvtOII ) :.;., 1'{A"r
PIlL)N~: O}~C~39'7 90 'Jr-: 13 A A ({,1 ~~ (I ,IV l '~r/~t-~ 1 tr ~~~, - r-..[-'J, L A~ ~s.,
WI IE AND CHILOREN NAME DATE OF
BUnH
PASSPORT
NUMBER
ISSUING
AUTHORITY
PLACE OF
ISSUING
l}1t~; , i f';l'~l U-·I:;L [[ "2. ... M "J-D,- 7',
i:unf<A 7 i+t?::,f).,(Lr'- -:L~G:Z Bf-O-}--Ol+
/ IS17'I! I~£"l , A:z..~-;'I..
i Db. f:.1-fl...FFIVI AP.b1,(/_A --;!.-tt."7
~/-V8-Do
'1--0E
nOC1 1lJENTS DOC. NO ISSUED EXPIRES ISSUING
AUTHORITY
ISSUING
PLACE
ISSPORT
Ac;t6f,
_Q05.2. ID - i - I ' [Y/ - , - I f
I', '(.,E:Tt.iA
; VF 1(; «1, le-" ~ l-Ic.. c.S
SEA lAN 'S BOOK-NATlONAL
SEAIv'1AN 'S BOOK-FLAG STATIJ I
~t.,
1.1. '17.;;. ;I. r -I"",: - - t''JDT i-A .'
"~ ~;.
SEAMAN'S BOOK·FLAG STA1 E 2
..1EDICAL CERTIFICATE OD2058 II-J-/I J , - ~,,- 1-:;' "~I II "'SA t 1 'L'L ~.:..'
VArON A.flON- YELLOW FEVER
15. SEAFARE'RS IDENTITY DOCUMENT. . . I
[A;PPLICATION F01lM3
, .I ..
.
APPLICATION No:
RANK :
C f-tf6F .f;:(0 CI t0t( -{;; :R
SEX: tvl r L I=
PERSONAL DETAILS:
MAIUTAL STATUS:
f~j-'w{f, I C- G
WEJGHT (kg) :
~()
DATE OF BiRTH r-)
.,~ ,
- ()'''' ~ 1~6 9
THERL NGUAGES:
P RESENT RESIDENTI At. ADDRESS
I -':~j''' /,>-v?" A i-I (..IV I S iKf:£;:T, 1 o.....,-t<.t:-7i
i.:-/" , ()S,
JC-j _ :;;';-JPHONE: C ~ '7 ' ~-J..SO 6'
E-mail:
Cl-{, 1""'(' ( , (" <:l! t-",,1-C, ~ d< v!~cr1)·· rc,,...,
SURNAME:
-f;£~ u-- A 'Z-£- E-/
GIVEN NAME:
f-'-...~-C:'- /t' "L- '1': "'" --~UA
-,
NATIONALITY: 1) {,. E-+:" I-i~i'.~
-RELIGION: 1 (" i -1, ~ ••- - I
1 STAT E OF ORJGl N ~-- --
';' 'f (}
L.G.A.:
It"-eY ~fi 1 ,.. - l~I:::,~'U-! V.. E..-sT _..
PLACE O F :RIRTH: ·'.f·~L ';" J" It-,j-,..J -
COLOUR UF' EYES: gR Cnl .l~ COLO Tn. O F HAm. ~ l-.-(- ('t.
SPECIFIC FEATURES:
- - ,
NAME AND ADDRESS OF NEXT OF KIN: /Y)/'...S. -A.J6b I...L- A -Z E:l:": .,L M l~ I)~'--lRA'
-),1 I f ('.I '~ t -p. ,:Z r' ~!.;. ....;·/J?.C£ 7, ,K S I - ~ &7 I .. L I A. _ +...:.;. •
RELATIONS!-HP: PHONE:10 r F-E.... C) v-D 6 is g' "7 tfl 0 "7 £ j
DOCUMENTS
I
INTERNATIO AL PASSPORT
-'
DlSCHARG E BOOK
MEDICAL C ERTJFlCATE
NATIO NAL IDENTITY CARD NO:
. , .. ~
EXPfRY ISSUEDOC. Nfl> ISSUED
DATE PLACE OF:DATE
OF:
-A D).6{.OC 0'1- U ( -I biU- 01- II t.. fG :.::-S5..2.
.~
i.--1C~t- c_1)5i-t· 21-0J-~7
/I- V I- II II-Clf - 13OD}..058 '--I'o..J
--_.
ISS{]ING
AUTHORITY
.
I <-rE 1'-.1;
. /.l."", , C, p-.. t,'j I ~~l
~" T
IJ IIYt/ ~ fy
I I ,' , .., ..' . ,'~~-' ' ,.-'I " "
CAREER DETAJLS:
PROFESSIONAL AND MANDATOR CERTTFJCATES:
QUA JFICATIONS DATE ISSUlW DAT E OF EXPffiV ISSUING AUT HORITY
C·,'-+:.I &~ (; .,' '. ,0 [- .r._/ .-r ''''' .~'.
'2
-
..