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Application Document

The document is a Seafarer Registration Application Form for Vitalis Mapuranga, a male from Zimbabwe, applying for the position of Security Officer with no prior sea experience. It includes personal information, statutory documents, medical fitness details, and an emergency contact. The applicant declares the information is accurate and consents to data processing for recruitment purposes.

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mapurangavitalis07
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3 views2 pages

Application Document

The document is a Seafarer Registration Application Form for Vitalis Mapuranga, a male from Zimbabwe, applying for the position of Security Officer with no prior sea experience. It includes personal information, statutory documents, medical fitness details, and an emergency contact. The applicant declares the information is accurate and consents to data processing for recruitment purposes.

Uploaded by

mapurangavitalis07
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Seafarer Registration Application Form

[Link] Information

Full Legal Name:_VITALIS MAPURANGA


Date of Birth: 06/10/1992
Place of Birth(City,Country):kwekwe ,Zimbabwe
Nationality: Zimbabwe
Gender:[*] Male [ ] Female [ ] Other
Permanent Address: 912 wattle Drive merlwood ,portshepstone
Phone Number: 0685485417
Email Address: obuksakpenejnr@[Link]

2. Professional Details & Rank


• Position/Rank Applied For: Security officer

• Department: [*] Deck [ ] Engine [ ] Catering [ ] Medical [ ] Other

• Total Years of Experience at Sea: none years

3. Statutory Documents & Certifications

Please provide the document number and expiry date for the following:
• Passport Number: EN 567575
• (Expiry: 09/06/2027)
• Seaman’s Book (CDC) No: __________ (Expiry: __________)
• SID (Seafarers Identity Doc): ______ (Expiry: __________)
• Certificate of Competency (CoC): ____ (Rank: __________)
• GMDSS Certificate No: ____________ (Expiry: __________)
• Yellow Fever Vaccination: [*] Yes [ ] No (Expir___12/2028_)
4. Medical Fitness

• ENG1 (or equivalent) Medical Expiry: None


• Drug & Alcohol Clearance Date: not yet done
• Blood Type: O
• List any known allergies/medical conditions: None

5. Last Vessel Experience(Optional only if you have previous experience)

• Vessel Name: _____________________


• Vessel Type (e.g., Tanker, Bulk, Container): ________
• GRT/BHP: _____________________
• Company Name: _____________________
• Sign-on/Sign-off Dates: _____________________

6. Emergency Contact Information

• Next of Kin : Promise Mapuranga


• Relationship: WIFE

• Contact Number: 0685485417

Declaration:

I hereby declare that the information provided above is true and correct to the best of
my knowledge. I understand that any false statements may disqualify me from
registration or employment. I also consent to the processing of my personal data for
recruitment and regulatory purposes.

Signature of Applicant: Vitalis Mapuranga

Date: 21 /01/2026

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