MONTECREW APPLICATION FORM Doc.

: F-A-1

Record of personal information, travel documents, certificates and past experience │

SURNAME & NAME Vukićević Mihajilo

RANK APPLIED FOR │ Third engineer
DATE AND PLACE OF BIRTH 22.09.1996
NATIONALITY Montenegrin
ADDRESS Vuka Karadžića bb.
PHONES/ E MAIL +38268589251

vukicevicmihajilo@[Link]
PERSONAL DATA DETAILS
HEIGHT 190 cm WEIGHT 90kg
HAIR COLOR black EYES COLOR Brown
OVERALL SAFETY Shoes 43
MARITAL STATUS Not mattied SKYPE ID
FATHER’S NAME Rajko MOTHER’S Žaklina
NEXT OF KIN: NAME/RELATION Vesna Drašković
PHONES/ E MAIL +38268057656
TRAVEL DOCUMENTS │
NUMBER ISSUE DATE EXPIRY DATE
(dd-mm-yy) (dd-mm-yy)
NATIONAL Seaman’s book: 0009402 22.11.2017 22.11.2027
FLAG Seaman’s book:
PASSPORT (1) P27EZ7627 21.07.2015 21.07.2027
PASSPORT (2)
USA VISA
AUS. SEAFARER’S VISA: 2009583922036 30.03.2020 30.03.2023
STCW CERTIFICATES│
NUMBER ISSUE DATE EXPIRY DATE
(dd-mm-yy) (dd-mm-yy)
Nat. License :
Grade:
Nat. License Endorsement
Grade:
Flag Endorsement (1):
Flag Name:
Flag Endorsement (2):
Flag Name:
Basic Training
Medical First Aid 08/4-345/22-1295/1 17.03.2022 17.03.2027
Surv. Craft & Rescue Boats 29440 17.06.2023
Fast Rescue Boat
Advanced Fire Fighting 29367 12.06.2023
Medical Care
Dangerous Cargo Handling
Radar & ARPA
GMDSS
Electronic Charts (Generic)
Electronic Charts (Specific)
Ship Security Officer
Designated security duties 08/4-345/22-1293/1 17.03.2022 17.03.2027
Security Awareness
Bridge Team Management

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MONTECREW APPLICATION FORM Doc.: F-A-1
Bridge Resource
Management
Engine Resource Management 12768 16.03.2023
Leadership and Team 12778 17.06.2023
Working Skills
Marine Environment Protect. 29413 16.06.2023
High Voltage 29423 16.06.2023
Ship Handling
Tankers:
Basic Oil & Chem. Tanker
Operation
Advanced Oil Tanker
Operation
Advanced Chem. Tanker
Operation
Basic Liquefied Gas Tankers
Advance Liquefied Gas
Tanker Operation
Passengers & Ro-Ro:
Crowd Management
Safety Train. for Person.
Prov. Dir. Serv. to Pass.
Crisis Management and
Human Behavior
Pass. Safety Cargo Safety
and Hull Integrity
Others:

SERVICES
Vessel Flag DWT/Trade Vessel Company Period (from-to)
Eng type/HP Type name Rank (dd-mm-yy)
KOTOR MNE Motor cargo Crnogorska Ship
ships plovidba mecha
nic 03.03.2020-21.10.2020
KOTOR MNE Motor cargo Crnogorska Ship
ships plovidba mecha
nic 24.05.2021-30.12.2021
KOTOR MNE Motor carge Crnogorska Trainee
ships plovidba for the
title of
navigatio
n watch
officer in
the
engine
deperme
nt 06.05.2022-18.04.2023
BOKA BAY MNE Remorker Boka pilot& Trainee
tug boat for the
services title of
d.o.o. navigati
on
watch
officer
in the
engine
deperm
ent 20.04.2023-15.05.2023

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MONTECREW APPLICATION FORM Doc.: F-A-1

MEDICAL CERTIFICATES
│Medical Certificate: Issued by: Medical centar Kotor Date: 20.02.2022
Vaccination card: │Yellow fever: Yes │Cholera: Yes

DECLARATION │
I hereby confirm that the above information is true and correct to the best of my knowledge. I agree that my personal
data can be sent to the partner companies and potential employers, in accordance with Reg. (EU) 2016/679 of the
European parliament and of the Council of 27.4.2016. in the protection of natural persons with regard to processing
of personal data and the free movement of such data and repealing Dir. 95/46 EC (GDPR) as well as with the
Montenegrin Law on protection of personal data (Official Gazette No. 44/12).

___28.06.2023__________________ ______Vukićević Mihajilo_________________

(Date) (Applicant's signature)

│FOR OFFICE USE:

Received by: Date: Updated by: Date:

Rev.4, Date 30.12.2021. App. by MA Page 3 of 3