Application Form OFC-007 (03-23)

Date of application: 18/12/2023 Please upload picture here

Name of manning agent: Aquamarine BD

General:
Last name: NION First name: RUBAYATUR RAHMAN
Date of birth: 04 JAN 1995 Place of birth: NETRAKONA
Address: 111/ARAMBAG , KENDUA, KENDUA City: NETRAKONA
Country: BANGLADESH Nationality: BANGLADESHI
Telephone: Mobile: +8801676561514
E-mail: rrnion@gmail.com Skype ID: rrnion@gmail.com
Position applying for: THIRD OFFICER
Available from: 01/01/2024

Sea history:
Vessel name Vessel Flag Rank DWT Maker, From Until Y/M/D Company
type model, (dd/mm/yyyy) (dd/mm/yyyy)
BHP/KW
MT. CHEM/ SOUTH D/C 11667 B&W, 19.04.16 24.04.17 1/0/5 Eastern Tanker
Dongyang OIL KOREA 6L35MC, Co. Ltd
Chemi 5281/3884
MT. ES CHEM/ Liberia J/O 13799 22.09.21 22.10.21 0/1/0 Pan Ocean
SPIRIT OIL Shipping Ltd
MT. ES CHEM/ Liberia 3/O 13799 22.10.21 08.06.22 0/7/1 Pan Ocean
SPIRIT OIL 7 Shipping Ltd
MT. Zhuang OIL Hong- 3/O 12000 20.11.22 07.08.23 0/8/1 SEACON SHIPS
Yuan Ao Kong 8
MANAGEMENT
CO.LTD

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 Application Form OFC-007 (03-23)

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Documents:
Document name: Country: Number: Place of issue: Date of issue: Expiry date:
Passport: BANGLADESH A12395148 DIP/DHAKA 10 SEP 2023 09 SEP 2033
Seamans book: BANGLADESH C/O/8705 CHITTAGONG 19 OCT 2020 18 OCT 2030
Others:

National license / endorsement:

Country: Number: Place of issue: Date of issue: Expiry date:
BANGLADESH 1.DC3.000487 DOS 06 MAY 2021 05 MAY 2026
Highest rank on endorsement: 2/O
Valid for chemical tankers: YES
Valid for oil tankers: YES

Other Flag State licenses:

Country: Number: Place of issue: Date of issue: Expiry date:
HONG KONG NL-277517 HONG KONG 25 NOV 2022 05 MAY 2026

Medical examination:
Country: Date of issue: Expiry date:
BANGLADESH 29.10.2022 28.10.2034

Vaccination Yellow Fever:

Date of issue: Expiry date:
31 OCT 2022 30 OCT 2032

Vaccination COVID-19:
Vaccination Type Date of issue:
MODERNA 18.07.2022
 Application Form OFC-007 (03-23)

Maritime education:
Grade: School: Country: Date (from – to):
PRE-SEA Western Maritime BANGLADESH 2013-2014
Academy
HND City Of Glasgow College, SCOTLAND, UK 2014-2015
UK

Others:
Weight: 77 KG
Height: 176.7cmcm
Marital Status: Married
Religion: ISLAM
Nearest international airport Hazrat Shahjalal International
Airport
Nearest domestic airport Shah Amanat International
Airport

Certifcates:
Date of issue: Expiry date:
Basic safety training, or:
Personal survival techniques 09.11.2023 08.10.2028
Fire prevention and fire fighting 09.11.2023 10.10.2028
Elementry First Aid 09.11.2023 10.10.2028
Personal Safety / Social Responsibility 09.11.2023 18.12.2028
Proficiency in survival craft / PSCRB 09.11.2023 13.10.2028
Advanced fire fighting 09.11.2023 08.10.2028
GMDSS 06.05.2021 05.05.2026
Medical care on board
Medical First aid 06.05.2021 11.10.2028
Radar navigator 06.05.2021 28.01.2026
Shiphandling (IMO model course 1.22)
Ship Security Officer 09.11.2023 08.11.2028
Designated Security Duties 09.11.2023 02.01.2029
ECDIS (generic – IMO model course 1.27, 40 hrs.) 09.11.2023 08.11.2028
ECDIS JRC type specific training
ECDIS FURUNO type specific training
ECDIS Sperry Marine type specific training
ECDIS Chart World type specific training
Tanker familiarization 01.08.2021 25.05.2026
Advanced chemical training 28.09.2022 15.08.2027
Advanced oil training 28.09.2022 27.08.2027
Ship Safety Officer 09.11.2023 31.12.2028
Ships Cook training certificate
Incident Investigation
Chemical Simulator
 Application Form OFC-007 (03-23)

Risk Assessment
Framo Pump Course
ME-B / ME-C Course

Visa:
Date of issue: Expiry date:
US Visa (C1/D)
Schengen visa

Next of kin: Capt. Nazia Zebin Julhash Relationship: Spouse

Telephone: +8801608897080 Date of birth:30 NOV 1995
Address:BNS Shaheed Moazzam, Notun Bazar, Kaptai, Rangamati Hilly Area, Chittagong

Next of kin:Rouzatur Rahman Oion Relationship:Brother

Telephone: +8801738442456 Date of birth:04 Jan 1995
Address:111/ Arambag, Kendua, Kendua, netrakona

Next of kin: Relationship:

Telephone: Date of birth:
Address:

Tanker Information Sheet - (For applications of Deck Officers, Bosun, Pumpman and deck ratings)

YES/NO Year* Rank** Yes/No Year* Rank**

Chemical Products Chemical Products
Aromatics: Perchlorethylene YES/NO Rank
Styrene NO Rank Trichlorethylene YES/NO Rank
Toluene YES 2016 D/C MDI/TDI YES/NO Rank
Benzene YES 2022 3/O Ethylene/Methylene Dichloride YES/NO Rank
Xylene YES 2022 3/O Styrene Monomer YES/NO Rank
Alcohols & Glykols YES/NO Rank MethylTert-Butyl Ether (MTBE) YES 2022 3/O
Methanol YES 2016 D/C Butyl Acetate YES/NO Rank
Ethanol YES/NO Rank Acetone YES/NO Rank
Iso-propyl Alcohol (IPA) YES/NO Rank Acrylonitrile YES/NO Rank
Butyl /Isobutyl Alcohol YES/NO Rank Caustic Soda YES/NO Rank
2-Ethylhexanol (Octanol) YES/NO Rank Chloroform YES/NO Rank
Mono Ethylene Glycol (MEG) YES/NO Rank Phenols YES/NO Rank
Molasses YES/NO Rank Propylene Oxide YES/NO Rank
Acids: Vinyl Acetate Monomer (VAM) YES/NO Rank
Phosphoric YES/NO Rank Urea Ammonia Nitrate YES/NO Rank
Sulphuric YES 2017 D/C Dowanol YES/NO Rank
Acrylic YES/NO Rank
Acetic YES/NO Rank Clean Petroleum Products (CPP):
Paraffins: Gasoil /Diesel Oil YES 2023 3/O
Slack Wax YES/NO Rank ULSD YES/NO Rank
Hexane YES/NO Rank Gasoline YES 2021 3/O
 Application Form OFC-007 (03-23)

Cyclohexane YES/NO Rank Naphta YES/NO Rank

Vegoils: Fuel Oil YES 2022 J/O
Such as Crude Palm Oil, YES/NO 2022 3/O Luboils YES 2016 D/C
Rapeseed Oil, Soyabean Oil,
Sunflower Oil, etc.

*Year: enter year of latest experience **Rank: enter highest rank of experience

Parcel Trade Exp. (max. no during single voyage): STS transfer (Max No. for last 2 yrs including ops at buoys):

Cargo Pumps Experience Tank’s Coating Type Experience

Deepwell: NO Expoxy YES
Framo YES Zinc Silicate NO
Marflex (electrical driven) NO Marineline NO
Centrifugal YES Stainless Steel YES
Screw YES Tank’s Passivation Experience NO
Steam Turbine NO Wall Wash Experience YES

SIRE Inspections (indicate which) SIRE 2.0

CDI Inspection (indicate date of last AROUND MARCH 2022
inspection)
USCG Inspection (indicate date of last
inspection)
Dry Dock Experience (indicate YEOSU OCEAN SHIPYARD, SOUTH KOREA/Zhoushan
shipyard) Xinya Shipyard Co.,Ltd
Experience in Delivery of New
Buildings
Trading Area (indicate areas) SINGAPORE, AUSTRALIA, MALAYSIA, VIETNAM, JAPAN,
SOUTH KOREA, CHINA, INDONESIA, PHILIPINES,
TAIWAN, MALDIVES, OMAN, UAE, SOUTH AFRICA,
ARGENTINA, URUGUYA, THAILAND
Ice Navigation Experience (indicate
areas)
Ship-to-Ship Experience (indicate VIETNAM, INDONESIA, BANGLADESH, CHINA, SOUTH
areas) KOREA, MALAYSIA
Multinational crew experience SOUTH KOREAN, BANGLADESHI, VIETNAMSE,
(indicate Nationality) INDONESIA, MYNMAR, CHINESE, MALAYSIAN

Annex I – data consent

Hereby, I Rubayatur Rahman Nion passport number A12395148 , give my consent that ASM Maritime INC. /
ASM Shipping LTD will hold and share with 3rd parties personal information as I provided for operational purposes
only which includes: flights, crew change formalities, immigration, port authorities and any other party supporting
the vessel’s operation. The personal information includes the following: Name, address, birth date, birth place, bank
account number, wage details, medical records, NOK, email, phone number, passport, STCW documents, national
documents, visas, flight records, sea service and PPE size.
 Application Form OFC-007 (03-23)

I declare that the information given by me is correct to the best of my knowledge and I
consent to disclosure of my personal information under the terms of the General Data
Protection Regulations. I am fully aware that my personal information will be used by the Employer for operational
reasons only.

Signature __________

Annex II – Background Checks

I hereby declare that:

 I have no allegiances or involvement with terrorist organizations

 I have no criminal records

Signature: _________________

For Manning Agent:

I hereby declare that:

 I confirm that crew declaration was verified and found true

 Reference check from previous employer:

Manning agent signature: ________________