Professional Documents
Culture Documents
001 Crew List Forms
001 Crew List Forms
VOY No.50 50
Date of arrival Last port of call Port of destination
1510.2
1510.2
IMO CREW LIST
Page No. 1
x Arrival Departure
1.1 Name of ship 1.2 IMO number 2. Port of arrival/departure 2. Date of arrival/departure
5LFJ7
4. Flage State of ship 5. Last port of call 6. Nature and No.of
identity
LIBERIA XIAMEN / CHINA document
7.No. 8.Family name,given name Sex 9.Rank of rating10.Nationality 11.Date and place of birth (seamen's book)
3 GANANCIAL SYDNEY DIMZON M 2nd Off. FILIPINO 05.12.1981 DUMANGAS ILOILO C1353678
7 OPLIMO KURT CAMELLO M 3rd Eng. FILIPINO 05.09.1968 INITAO MIS OR A0100289
14 NAVARRO JOHN MICHAEL SENORIN M O/S FILIPINO 30.08.1996 GLORIA OR MDO C1470329
17 TABBU JAN KENNETH GUINTU M Motorman FILIPINO 18.05.1996 CALOOCAN CITY A0085430
21 SALAC ARTURO JR. MARQUEZ M D/Cadet FILIPINO 06.07.1997 ANGELES CITY A0118822
23 CABARDO BRENT AXEL CARVAJAL M E/Cadet FILIPINO 01.10.1998 BOLINAO PGN C1302519
24 0 0 0 0 0 0 30.12.1899 0 0
25 0 0 0 0 0 0 30.12.1899 0 0
26 0 0 0 0 0 0 30.12.1899 0 0
12.
IMO
FAL
Form 5
IMO CREW LIST
1.Voyage number 2.Call Sign 3.Page No:
X
ARRIVAL DEPARTURE
50 5LFJ7 1
4.Name of Ship 5.Port of Arrival / Departure 6.Date of arrival/departure
1 KIDA CEZARY 0 M Master POLISH 02.05.1973 PYRZYCE FA0627444 ### HAYDARPASA 30.07.2022
CHERNIVECKA
2 SHOVA DMYTRO 0 M Chief off. UKRAINE 04.10.1963
OBL FK893942 ### KOPER 10.08.2022
DUMANGAS
3 GANANCIAL SYDNEY DIMZON M 2nd Off. FILIPINO 05.12.1981 ILOILO P7158288B 07.07.2031 SINGAPORE 28.09.2022
4 NAUMENKO DANYIL 0 M 3rd Off. UKRAINE 15.03.2002 ODESA FZ669776 ### HAYDARPASA 26.07.2022
5 CYGANIK SEBASTIAN MARIUSZ M Ch.Eng. POLISH 07.10.1978 KRAKOW EK5008551 ### HAYDARPASA 30.07.2022
IMO Convention on Facilitation of Ingternational Maritime Traffic
6 KWIATKOWSKI SYLWESTER WIESLAW M 2nd Eng. POLISH 31.12.1967 LIPNO EU0304124 12.05.2031 SUEZ 31.08.2022
7 OPLIMO KURT CAMELLO M 3rd Eng. FILIPINO 05.09.1968 INITAO MIS OR P7208313A ### VITORIA 08.02.2022
8 KRZEMINSKI WOJCIECH JAN M Electrician POLISH 30.11.1981 BYDGOSZCZ EK5819407 20.10.2026 BURGAS 24.08.2022
9 MIRASOL EFREN FRIOLO M Boatswain FILIPINO 07.03.1961 OSLOB, CEBU P2279958B ### SUEZ 13.07.2022
10 MONTEFALCON GERSON DAGATAN M D/Ftr FILIPINO 29.01.1988 ILIGAN CITY P9345510B ### SUEZ 13.07.2022
11 ABENIDO ELFIE EBERO M A/B FILIPINO 20.05.1985 DAVAO CITY P9905060B 03.05.2032 SINGAPORE 28.09.2022
TAGBILARAN
12 ENERO CORCINE JR ESTOCE M A/B FILIPINO 04.06.1980 CITY P6970875B 11.06.2031 SINGAPORE 28.09.2022
KIBAWE
13 RESABAL HERMES JR LEGASPINO M A/B FILIPINO 04.01.1995 BUKIDNON P9449602A ### HAYDARPASA 22.07.2022
JOHN
NAVARRO
14###
MICHAEL
SENORIN M O/S FILIPINO 30.08.1996 GLORIA OR MDO P6138861B 20.01.2031 SINGAPORE 28.09.2022
LASAM,
MONTANEZ
15### RENATO JR UMANGAY M O/S FILIPINO 15.12.1996 CAGAYAN P5566174A ### SUEZ 13.07.2022
GABRIEL
16### PHILIP DALO M Storekeep. FILIPINO 20.05.1974 MANILA P5810744A ### MASAN 03.06.2022
JAN
TABBU
17###
KENNETH
GUINTU M Motorman FILIPINO 18.05.1996 CALOOCAN CITY P5422647B ### SUEZ 13.07.2022
SHTEFAN
18### OLEKSII 0 M Cook UKRAINE 10.05.1986 ODESA FN394068 18.04.2028 KOPER 11.08.2022
AYCO
19### FREDIMARK PEPITO M Steward FILIPINO 14.12.1995 DIGOS DVO DS P7154800B ### SUEZ 13.07.2022
MADRIDEJOS,
DIONGSON
20### STEPHEN SANTILLAN M D/Cadet FILIPINO 02.12.1999 CEBU P8601143B ### SUEZ 13.07.2022
SALAC
21### ARTURO JR. MARQUEZ M D/Cadet FILIPINO 06.07.1997 ANGELES CITY P0466276C ### SUEZ 13.07.2022
SOTILLO
22### RAFFY ILIGAN M E/Cadet FILIPINO 27.03.1996 DUMARAO CAPIZ P6423765A ### SUEZ 13.07.2022
CABARDO
23### BRENT AXEL CARVAJAL M E/Cadet FILIPINO 01.10.1998 BOLINAO PGN P9616824A ### SUEZ 13.07.2022
25
26
IMO
FAL
Form 5
IMO CREW LIST
Page No. 1
X Arrival Departure
1.1 Name of ship 1.2 IMO number 2. Port of arrival/departure 2. Date of arrival/departure
5LFJ7
4. Flage State of ship 5. Last port of call 6. Nature and No.of
2 SHOVA DMYTRO 0 M Chief off. UKRAINE 1963/10/04 CHERNIVECKA OBL FK893942 2028/01/15
3 GANANCIAL SYDNEY DIMZON M 2nd Off. FILIPINO 05.12.1981 DUMANGAS ILOILO P7158288B 07.07.2031
6 KWIATKOWSKI SYLWESTER WIESLAW M 2nd Eng. POLISH 31.12.1967 POLISH EU0304124 12.05.2031
7 OPLIMO KURT CAMELLO M 3rd Eng. FILIPINO 1968/09/05 INITAO MIS OR P7208313A 2028/05/16
9 MIRASOL EFREN FRIOLO M Boatswain FILIPINO 1961/03/07 OSLOB, CEBU P2279958B 2029/05/23
10 MONTEFALCON GERSON DAGATAN M D/Ftr FILIPINO 1988/01/29 ILIGAN CITY P9345510B 2032/03/24
11 ABENIDO ELFIE EBERO M A/B FILIPINO 20.05.1985 DAVAO CITY P9905060B 03.05.2032
12 ENERO CORCINE JR ESTOCE M A/B FILIPINO 04.06.1980 TAGBILARAN CITY P6970875B 11.06.2031
13 RESABAL HERMES JR LEGASPINO M A/B FILIPINO 1995/01/04 KIBAWE BUKIDNON P9449602A 2028/11/06
JOHN
14 NAVARRO
MICHAEL
SENORIN M O/S FILIPINO 30.08.1996 GLORIA OR MDO P6138861B 20.01.2031
15 MONTANEZ RENATO JR UMANGAY M O/S FILIPINO 1996/12/15 LASAM, CAGAYAN P5566174A 2028/01/09
JAN
17 TABBU
KENNETH
GUINTU M Motorman FILIPINO 1996/05/18 CALOOCAN CITY P5422647B 2030/08/19
19 AYCO FREDIMARK PEPITO M Steward FILIPINO 1995/12/14 DIGOS DVO DS P7154800B 2031/07/07
20 DIONGSON STEPHEN SANTILLAN M D/Cadet FILIPINO 1999/12/02 MADRIDEJOS, CEBU P8601143B 2031/12/29
21 SALAC ARTURO JR. MARQUEZ M D/Cadet FILIPINO 1997/07/06 ANGELES CITY P0466276C 2032/06/09
22 SOTILLO RAFFY ILIGAN M E/Cadet FILIPINO 1996/03/27 DUMARAO CAPIZ P6423765A 2028/03/14
23 CABARDO BRENT AXEL CARVAJAL M E/Cadet FILIPINO 1998/10/01 BOLINAO PGN P9616824A 2028/11/19
24 0 0 0 0 0 0 1899/12/30 0 0 1899/12/30
25 0 0 0 0 0 0 1899/12/30 0 0
12.
IMO FAL
Form 5
Page No.
IMO CREW LIST
Page No. 1
Arrival X Departure
1.1 Name of ship 1.2 IMO number 2. Port of arrival/departure 2. Date of arrival/departure
5LFJ7
4. Flage State of ship 5. Next Port 6. Nature and No.of
identity document
LIBERIA XIAMEN / CHINA
7.No. 8.Family name,given name Sex 9.Rank of rating10.Nationality 11.Date and place of birth (passports)
3 GANANCIAL SYDNEY DIMZON M 2nd Off. FILIPINO 05.12.1981 DUMANGAS ILOILO P7158288B
7 OPLIMO KURT CAMELLO M 3rd Eng. FILIPINO 05.09.1968 INITAO MIS OR P7208313A
IMO Convention on Facilitation of Ingternational Maritime Traffic
21 SALAC ARTURO JR. MARQUEZ M D/Cadet FILIPINO 06.07.1997 ANGELES CITY P0466276C
23 CABARDO BRENT AXEL CARVAJAL M E/Cadet FILIPINO 01.10.1998 BOLINAO PGN P9616824A
24 0 0 0 0 0 0 30.12.1899 0 0
25
26
12. Date and signature by master, authorized agent or officer
IMO FAL
Form 5
IMO CREW LIST
Page No. 1
Arrival X Departure
1.1 Name of ship 1.2 IMO number 2. Port of arrival/departure 2. Date of arrival/departure
5LFJ7
4. Flage State of ship 5. Next Port 6. Nature and No.of
identity document
LIBERIA XIAMEN / CHINA (seamen's book expire date
7.No. 8.Family name,given name Sex 9.Rank of rating10.Nationality 11.Date and place of birth or passport)
2 SHOVA DMYTRO 0 M Chief off. UKRAINE 1963/10/04 CHERNIVECKA OBL AB530325 12/02/2024
3 GANANCIAL SYDNEY DIMZON M 2nd Off. FILIPINO 05.12.1981 DUMANGAS ILOILO C1353678 11.04.2029
6 KWIATKOWSKI SYLWESTER WIESLAW M 2nd Eng. POLISH 31.12.1967 POLISH 0157842 12.05.2031
7 OPLIMO KURT CAMELLO M 3rd Eng. FILIPINO 1968/09/05 INITAO MIS OR A0100289 26/11/2030
IMO Convention on Facilitation of Ingternational Maritime Traffic
9 MIRASOL EFREN FRIOLO M Boatswain FILIPINO 1961/03/07 OSLOB, CEBU C0919591 24/09/2026
10 MONTEFALCON GERSON DAGATAN M D/Ftr FILIPINO 1988/01/29 ILIGAN CITY C1239535 03/12/2028
11 ABENIDO ELFIE EBERO M A/B FILIPINO 20.05.1985 DAVAO CITY C1096637 30.07.2027
12 ENERO CORCINE JR ESTOCE M A/B FILIPINO 04.06.1980 TAGBILARAN CITY C1298219 29.06.2028
13 RESABAL HERMES JR LEGASPINO M A/B FILIPINO 1995/01/04 KIBAWE BUKIDNON C1432498 08/02/2029
JOHN
14 NAVARRO
MICHAEL
SENORIN M O/S FILIPINO 30.08.1996 GLORIA OR MDO C1470329 24.04.2029
15 MONTANEZ RENATO JR UMANGAY M O/S FILIPINO 1996/12/15 LASAM, CAGAYAN C1151587 21/10/2027
JAN
17 TABBU
KENNETH
GUINTU M Motorman FILIPINO 1996/05/18 CALOOCAN CITY A0085430 20/08/2030
19 AYCO FREDIMARK PEPITO M Steward FILIPINO 1995/12/14 DIGOS DVO DS C1570812 18/12/2029
20 DIONGSON STEPHEN SANTILLAN M D/Cadet FILIPINO 1999/12/02 MADRIDEJOS, CEBU A0152720 27/10/2031
21 SALAC ARTURO JR. MARQUEZ M D/Cadet FILIPINO 1997/07/06 ANGELES CITY A0118822 03/05/2031
22 SOTILLO RAFFY ILIGAN M E/Cadet FILIPINO 1996/03/27 DUMARAO CAPIZ C0925774 25.12.2026
23 CABARDO BRENT AXEL CARVAJAL M E/Cadet FILIPINO 1998/10/01 BOLINAO PGN C1302519 14/12/2028
24 0 0 0 0 0 0 1899/12/30 0 0 30/12/1899
IMO FAL
Form 5
IMO CREW LIST
1.Voyage number 2.Call Sign 3.Page No:
X
ARRIVAL DEPARTURE
50 5LFJ7 1
4.Name of Ship 5.Port of Arrival / Departure 6.Date of arrival/departure
1 KIDA CEZARY 0 M Master POLISH 02.05.1973 PYRZYCE FA0627444 23.05.2032 AA0003863 11.04.2027
CHERNIVECKA
2 SHOVA DMYTRO 0 M Chief off. UKRAINE 04.10.1963 OBL FK893942 15.01.2028 AB530325 12.02.2024
DUMANGAS
3 GANANCIAL SYDNEY DIMZON M 2nd Off. FILIPINO 05.12.1981 ILOILO P7158288B 07.07.2031 C1353678 11.04.2029
4 NAUMENKO DANYIL 0 M 3rd Off. UKRAINE 15.03.2002 ODESA FZ669776 09.12.2030 AB623174 17.05.2023
5 CYGANIK SEBASTIAN MARIUSZ M Ch.Eng. POLISH 07.10.1978 KRAKOW EK5008551 08.04.2026 AA0004825 19.02.2029
IMO Convention on Facilitation of Ingternational Maritime Traffic
6 KWIATKOWSKI SYLWESTER WIESLAW M 2nd Eng. POLISH 31.12.1967 LIPNO EU0304124 12.05.2031 0157842 PERMANENT
7 OPLIMO KURT CAMELLO M 3rd Eng. FILIPINO 05.09.1968 INITAO MIS OR P7208313A 16.05.2028 A0100289 26.11.2030
8 KRZEMINSKI WOJCIECH JAN M Electrician POLISH 30.11.1981 BYDGOSZCZ EK5819407 20.10.2026 0239028 PERMANENT
9 MIRASOL EFREN FRIOLO M BoatswainFILIPINO 07.03.1961 OSLOB, CEBU P2279958B 23.05.2029 C0919591 24.09.2026
10 MONTEFALCON GERSON DAGATAN M D/Ftr FILIPINO 29.01.1988 ILIGAN CITY P9345510B 24.03.2032 C1239535 03.12.2028
11 ABENIDO ELFIE EBERO M A/B FILIPINO 20.05.1985 DAVAO CITY P9905060B 03.05.2032 C1096637 30.07.2027
TAGBILARAN
12 ENERO CORCINE JR ESTOCE M A/B FILIPINO 04.06.1980 CITY P6970875B 11.06.2031 C1298219 29.06.2028
KIBAWE
13 RESABAL HERMES JR LEGASPINO M A/B FILIPINO 04.01.1995 BUKIDNON P9449602A 06.11.2028 C1432498 08.02.2029
JOHN
14 NAVARRO
MICHAEL
SENORIN M O/S FILIPINO 30.08.1996 GLORIA OR MDO P6138861B 20.01.2031 C1470329 24.04.2029
LASAM,
15 MONTANEZ RENATO JR UMANGAY M O/S FILIPINO 15.12.1996 CAGAYAN P5566174A 09.01.2028 C1151587 21.10.2027
16 GABRIEL PHILIP DALO M Storekeep.FILIPINO 20.05.1974 MANILA P5810744A 28.01.2028 C1218304 12.02.2028
17 TABBU JAN KENNETH GUINTU M Motorman FILIPINO 18.05.1996 CALOOCAN CITY P5422647B 19.08.2030 A0085430 20.08.2030
18 SHTEFAN OLEKSII 0 M Cook UKRAINE 10.05.1986 ODESA FN394068 18.04.2028 AB693842 06.07.2027
19 AYCO FREDIMARK PEPITO M Steward FILIPINO 14.12.1995 DIGOS DVO DS P7154800B 07.07.2031 C1570812 18.12.2029
MADRIDEJOS,
20 DIONGSON STEPHEN SANTILLAN M D/Cadet FILIPINO 02.12.1999 CEBU P8601143B 29.12.2031 A0152720 27.10.2031
21 SALAC ARTURO JR. MARQUEZ M D/Cadet FILIPINO 06.07.1997 ANGELES CITY P0466276C 09.06.2032 A0118822 03.05.2031
22 SOTILLO RAFFY ILIGAN M E/Cadet FILIPINO 27.03.1996 DUMARAO CAPIZ P6423765A 14.03.2028 C0925774 25.12.2026
23 CABARDO BRENT AXEL CARVAJAL M E/Cadet FILIPINO 01.10.1998 BOLINAO PGN P9616824A 19.11.2028 C1302519 14.12.2028
IMO
FAL
Form 5
IMO CREW LIST
1.Voyage number 2.Call Sign 3.Page No:
X
ARRIVAL DEPARTURE
50 5LFJ7 1
4.Name of Ship 5.Port of Arrival / Departure 6.Date of arrival/departure
1 KIDA CEZARY 0 M Master POLISH 02.05.1973 PYRZYCE FA0627444 ### AA0003863 11.04.2027
CHERNIVECKA
2 SHOVA DMYTRO 0 M Chief off. UKRAINE 04.10.1963 OBL FK893942 ### AB530325 12.02.2024
DUMANGAS
3 GANANCIAL SYDNEY DIMZON M 2nd Off. FILIPINO 05.12.1981 ILOILO P7158288B 07.07.2031 C1353678 11.04.2029
4 NAUMENKO DANYIL 0 M 3rd Off. UKRAINE 15.03.2002 ODESA FZ669776 ### AB623174 17.05.2023
5 CYGANIK SEBASTIAN MARIUSZ M Ch.Eng. POLISH 07.10.1978 KRAKOW EK5008551 ### AA0004825 19.02.2029
6 KWIATKOWSKI SYLWESTER WIESLAW M 2nd Eng. POLISH 31.12.1967 LIPNO EU0304124 12.05.2031 0157842 PERMANENT
IMO Convention on Facilitation of Ingternational Maritime Traffic
7 OPLIMO KURT CAMELLO M 3rd Eng. FILIPINO 05.09.1968 INITAO MIS OR P7208313A ### A0100289 26.11.2030
8 KRZEMINSKI WOJCIECH JAN M Electrician POLISH 30.11.1981 BYDGOSZCZ EK5819407 20.10.2026 0239028 PERMANENT
9 MIRASOL EFREN FRIOLO M Boatswain FILIPINO 07.03.1961 OSLOB, CEBU P2279958B ### C0919591 24.09.2026
10 MONTEFALCON GERSON DAGATAN M D/Ftr FILIPINO 29.01.1988 ILIGAN CITY P9345510B ### C1239535 03.12.2028
11 ABENIDO ELFIE EBERO M A/B FILIPINO 20.05.1985 DAVAO CITY P9905060B 03.05.2032 C1096637 30.07.2027
TAGBILARAN
12 ENERO CORCINE JR ESTOCE M A/B FILIPINO 04.06.1980 CITY P6970875B 11.06.2031 C1298219 29.06.2028
KIBAWE
13 RESABAL HERMES JR LEGASPINO M A/B FILIPINO 04.01.1995 BUKIDNON P9449602A ### C1432498 08.02.2029
14 NAVARRO JOHN MICHAEL SENORIN M O/S FILIPINO 30.08.1996 GLORIA OR MDO P6138861B 20.01.2031 C1470329 24.04.2029
LASAM,
15 MONTANEZ RENATO JR UMANGAY M O/S FILIPINO 15.12.1996 CAGAYAN P5566174A ### C1151587 21.10.2027
16 GABRIEL PHILIP DALO M Storekeep.FILIPINO 20.05.1974 MANILA P5810744A ### C1218304 12.02.2028
17 TABBU JAN KENNETH GUINTU M Motorman FILIPINO 18.05.1996 CALOOCAN CITY P5422647B ### A0085430 20.08.2030
18 SHTEFAN OLEKSII 0 M Cook UKRAINE 10.05.1986 ODESA FN394068 18.04.2028 AB693842 06.07.2027
19 AYCO FREDIMARK PEPITO M Steward FILIPINO 14.12.1995 DIGOS DVO DS P7154800B ### C1570812 18.12.2029
MADRIDEJOS,
20 DIONGSON STEPHEN SANTILLAN M D/Cadet FILIPINO 02.12.1999 CEBU P8601143B ### A0152720 27.10.2031
21 SALAC ARTURO JR. MARQUEZ M D/Cadet FILIPINO 06.07.1997 ANGELES CITY P0466276C ### A0118822 03.05.2031
22 SOTILLO RAFFY ILIGAN M E/Cadet FILIPINO 27.03.1996 DUMARAO CAPIZ P6423765A ### C0925774 25.12.2026
23 CABARDO BRENT AXEL CARVAJAL M E/Cadet FILIPINO 01.10.1998 BOLINAO PGN P9616824A ### C1302519 14.12.2028
IMO
FAL
Form 5
IMO CREW LIST
1.Voyage number 2.Call Sign 3.Page No:
X
ARRIVAL DEPARTURE
50 5LFJ7 1
4.Name of Ship 5.Port of Arrival / Departure 6.Date of arrival/departure
1 KIDA CEZARY 0 M Master POLISH 02.05.1973 PYRZYCE FA0627444 ### AA0003863 11.04.2027
CHERNIVECKA
2 SHOVA DMYTRO M Chief off. UKRAINE 04.10.1963 OBL FK893942 ### AB530325 12.02.2024
DUMANGAS
3 GANANCIAL SYDNEY DIMZON M 2nd Off. FILIPINO 05.12.1981 ILOILO P7158288B 07.07.2031 C1353678 11.04.2029
4 NAUMENKO DANYIL M 3rd Off. UKRAINE 15.03.2002 ODESA FZ669776 ### AB623174 5/17/2023
5 CYGANIK SEBASTIAN M Ch.Eng. POLISH 07.10.1978 KRAKOW EK5008551 ### AA0004825 19.02.2029
6 KWIATKOWSKI SYLWESTER WIESLAW M 2nd Eng. POLISH 31.12.1967 LIPNO EU0304124 12.05.2031 0157842 PERMANENT
IMO Convention on Facilitation of Ingternational Maritime Traffic
7 OPLIMO KURT CAMELLO M 3rd Eng. FILIPINO 05.09.1968 INITAO MIS OR P7208313A ### A0100289 26.11.2030
8 KRZEMINSKI WOJCIECH JAN M Electrician POLISH 30.11.1981 BYDGOSZCZ EK5819407 20.10.2026 0239028 PERMANENT
9 MIRASOL EFREN FRIOLO M BoatswainFILIPINO 07.03.1961 OSLOB, CEBU P2279958B ### C0919591 24.09.2026
10 MONTEFALCON GERSON DAGATAN M D/Ftr FILIPINO 29.01.1988 ILIGAN CITY P9345510B ### C1239535 03.12.2028
11 ABENIDO ELFIE EBERO M A/B FILIPINO 20.05.1985 DAVAO CITY P9905060B 03.05.2032 C1096637 30.07.2027
TAGBILARAN
12 ENERO CORCINE JR ESTOCE M A/B FILIPINO 04.06.1980 CITY P6970875B 11.06.2031 C1298219 29.06.2028
KIBAWE
13 RESABAL HERMES JR LEGASPINO M A/B FILIPINO 04.01.1995 BUKIDNON P9449602A ### C1432498 08.02.2029
14 NAVARRO JOHN MICHAEL SENORIN M O/S FILIPINO 30.08.1996 GLORIA OR MDO P6138861B 20.01.2031 C1470329 24.04.2029
LASAM,
15 MONTANEZ RENATO JR UMANGAY M O/S FILIPINO 15.12.1996 CAGAYAN P5566174A ### C1151587 21.10.2027
16 GABRIEL PHILIP DALO M Storekeep.FILIPINO 20.05.1974 MANILA P5810744A ### C1218304 12.02.2028
17 TABBU JAN KENNETH GUINTU M Motorman FILIPINO 18.05.1996 CALOOCAN CITY P5422647B ### A0085430 20.08.2030
18 SHTEFAN OLEKSII 0 M Cook UKRAINE 10.05.1986 ODESA FN394068 18.04.2028 AB693842 06.07.2027
19 AYCO FREDIMARK PEPITO M Steward FILIPINO 14.12.1995 DIGOS DVO DS P7154800B ### C1570812 18.12.2029
MADRIDEJOS,
20 DIONGSON STEPHEN SANTILLAN M D/Cadet FILIPINO 02.12.1999 CEBU P8601143B ### A0152720 27.10.2031
21 SALAC ARTURO JR. MARQUEZ M D/Cadet FILIPINO 06.07.1997 ANGELES CITY P0466276C ### A0118822 03.05.2031
22 SOTILLO RAFFY ILIGAN M E/Cadet FILIPINO 27.03.1996 DUMARAO CAPIZ P6423765A ### C0925774 25.12.2026
23 CABARDO BRENT AXEL CARVAJAL M E/Cadet FILIPINO 01.10.1998 BOLINAO PGN P9616824A ### C1302519 14.12.2028
IMO
FAL
Form 5
CREW
LIST
PP03-F04
Arrival X Departure
1.1 Ship name: KRASZEWSKI 2. Port of arrival/departure: 3.Date of arrival/departure
1.2 IMO No. 9432153
NANJING / CHINA 13.10.2022
1.3 Call sign: 5LFJ7
4. Flag State of ship: 5. Last port of call: 6. Nature & No.of
LIBERIA XIAMEN / CHINA
ID document/
7. 9. Rank or Seaman's Book
8. Family Name, given names 10. Nationality 11. Date & place of birth
No. rating
ES
T
Other items
ET
S
IT
R
E
A
IR
IN
IG
SP
W
C
2 X PHONE; 1X LAPTOP; 2 X HDD; 1 X;1 X
1 KIDA CEZARY Master HEADPHONES;
1XCELLPHONE,1XHDD,3XUSB,1x LAPTOP;R.E;1X AP
3 GANANCIAL SYDNEY 2nd Off. MONITOR
1xCELLPHONE,LAPTOP,1XHDD,VAR.EFFECTS
11 ABENIDO ELFIE A/B
CELLPHONE,LAPTOP,WATCH,CAMERA, 1 X
JOHN
14 NAVARRO MICHAEL
O/S TABLETP/E
X
ARRIVAL DEPARTURE
50 5LFJ7 1
4.Name of Ship 5.Port of Arrival / Departure 6.Date of arrival/departure
CHERNIVECKA
2 SHOVA DMYTRO 0 Chief off. UKRAINE ### OBL
unlimited
DUMANGAS
3 GANANCIAL SYDNEY DIMZON 2nd Off. FILIPINO05.12.1981 ILOILO
unlimited
7 OPLIMO KURT CAMELLO 3rd Eng. FILIPINO ### INITAO MIS OR unlimited
TAGBILARAN
12 ENERO CORCINE JR ESTOCE A/B FILIPINO04.06.1980 CITY
unlimited
KIBAWE
13 RESABAL HERMES JR LEGASPINO A/B FILIPINO ### BUKIDNON
unlimited
JOHN
14 NAVARRO MICHAEL
SENORIN O/S FILIPINO30.08.1996 GLORIA OR MDO unlimited
LASAM,
15 MONTANEZ RENATO JR UMANGAY O/S FILIPINO ### CAGAYAN
unlimited
17 TABBU JAN KENNETH GUINTU Motorman FILIPINO ### CALOOCAN CITY unlimited
MADRIDEJOS,
20 DIONGSON STEPHEN SANTILLAN D/Cadet FILIPINO ### CEBU
unlimited
21 SALAC ARTURO JR. MARQUEZ D/Cadet FILIPINO ### ANGELES CITY unlimited
23 CABARDO BRENT AXEL CARVAJAL E/Cadet FILIPINO ### BOLINAO PGN unlimited
IMO
FAL
Form 5
VACCINATION LIST COVID-19
1.Voyage number 2.Call Sign 3.PAGE No:
X
ARRIVAL DEPARTURE
50 5LFJ7 1
4.Name of Ship 5.Port of Arrival / Departure 6.Date of arrival/departure
CHERNIVECKA
2 SHOVA DMYTRO 0 Chief off. UKRAINE ### OBL
15.07.2022 Pfizer
DUMANGAS
3 GANANCIAL SYDNEY DIMZON 2nd Off. FILIPINO05.12.1981 ILOILO
13.02.2022 Pfizer
6 KWIATKOWSKI SYLWESTER WIESLAW 2nd Eng. POLISH 31.12.1967 LIPNO 17.02.2022 Pfizer
7 OPLIMO KURT CAMELLO 3rd Eng. FILIPINO ### INITAO MIS OR 10.09.2021 Pfizer
9 MIRASOL EFREN FRIOLO Boatswain FILIPINO ### OSLOB, CEBU 16.09.2021 Pfizer
10 MONTEFALCON GERSON DAGATAN D/Ftr FILIPINO ### ILIGAN CITY 07.07.2022 Moderna
TAGBILARAN
12 ENERO CORCINE JR ESTOCE A/B FILIPINO04.06.1980 CITY
29.07.2022 Pfizer
KIBAWE
13 RESABAL HERMES JR LEGASPINO A/B FILIPINO ### BUKIDNON
24.06.2022 Pfizer
JOHN
14 NAVARRO MICHAEL
SENORIN O/S FILIPINO30.08.1996 GLORIA OR MDO 04.07.2022 Pfizer
LASAM,
15 MONTANEZ RENATO JR UMANGAY O/S FILIPINO ### CAGAYAN
23.03.2022 Pfizer
17 TABBU JAN KENNETH GUINTU Motorman FILIPINO ### CALOOCAN CITY 03.11.2021 Pfizer
19 AYCO FREDIMARK PEPITO Steward FILIPINO ### DIGOS DVO DS 01.04.2022 ASTRA ZENECA
MADRIDEJOS,
20 DIONGSON STEPHEN SANTILLAN D/Cadet FILIPINO ### CEBU
17.03.2022 Pfizer
21 SALAC ARTURO JR. MARQUEZ D/Cadet FILIPINO ### ANGELES CITY 31.01.2022 Moderna
22 SOTILLO RAFFY ILIGAN E/Cadet FILIPINO ### DUMARAO CAPIZ 14.09.2021 ASTRA ZENECA
23 CABARDO BRENT AXEL CARVAJAL E/Cadet FILIPINO ### BOLINAO PGN 23.09.2021 Moderna
17.DATE AND SIGNATURE BY MASTER, AUTHORISED AGENT OR OFFICER
IMO
FAL
Form 5
VACCINATION LIST
1.Voyage number 2.Call Sign 3.PAGE No:
X
ARRIVAL DEPARTURE
50 5LFJ7 1
4.Name of Ship 5.Port of Arrival / Departure 6.Date of arrival/departure
CHERNIVECKA
2 SHOVA DMYTRO 0 Chief off. UKRAINE ### OBL
13.07.2024 22.09.2014 unlimited
DUMANGAS
3 GANANCIAL SYDNEY DIMZON 2nd Off. FILIPINO 05.12.1981 ILOILO
11.09.2024 27.09.2015 unlimited
4 NAUMENKO DANYIL 0 3rd Off. UKRAINE ### ODESA 02.11.2023 13.04.2018 unlimited
5 CYGANIK SEBASTIAN MARIUSZ Ch.Eng. POLISH ### KRAKOW 13.07.2023 07.11.2013 unlimited
6 KWIATKOWSKI SYLWESTER WIESLAW 2nd Eng. POLISH 31.12.1967 LIPNO 19.07.2023 16.11.2011 unlimited
IMO Convention on Facilitation of Ingternational Maritime Traffic
7 OPLIMO KURT CAMELLO 3rd Eng. FILIPINO ### INITAO MIS OR 16.12.2023 30.03.2012 unlimited
8 KRZEMINSKI WOJCIECH JAN Electrician POLISH 30.11.1981 BYDGOSZCZ 19.08.2023 02.07.2008 unlimited
9 MIRASOL EFREN FRIOLO Boatswain FILIPINO ### OSLOB, CEBU 12.05.2024 13.01.2011 unlimited
10 MONTEFALCON GERSON DAGATAN D/Ftr FILIPINO ### ILIGAN CITY 06.07.2024 09.05.2019 unlimited
11 ABENIDO ELFIE EBERO A/B FILIPINO 20.05.1985 DAVAO CITY 13.07.2024 29.03.2015 unlimited
TAGBILARAN
12 ENERO CORCINE JR ESTOCE A/B FILIPINO 04.06.1980 CITY
08.09.2024 07.06.2008 unlimited
KIBAWE
13 RESABAL HERMES JR LEGASPINO A/B FILIPINO ### BUKIDNON
30.06.2024 15.10.2014 unlimited
JOHN
14 NAVARRO MICHAEL
SENORIN O/S FILIPINO 30.08.1996 GLORIA OR MDO 05.09.2024 20.12.2020 unlimited
LASAM,
15 MONTANEZ RENATO JR UMANGAY O/S FILIPINO ### CAGAYAN
27.06.2024 27.03.2019 unlimited
16 GABRIEL PHILIP DALO Storekeep. FILIPINO ### MANILA 25.05.2024 03.10.2013 unlimited
17 TABBU JAN KENNETH GUINTU Motorman FILIPINO ### CALOOCAN CITY 17.05.2024 26.02.2016 unlimited
19 AYCO FREDIMARK PEPITO Steward FILIPINO ### DIGOS DVO DS 21.04.2024 26.11.2020 unlimited
MADRIDEJOS,
20 DIONGSON STEPHEN SANTILLAN D/Cadet FILIPINO ### CEBU
19.05.2024 01.04.2022 unlimited
21 SALAC ARTURO JR. MARQUEZ D/Cadet FILIPINO ### ANGELES CITY 01.05.2024 22.06.2022 unlimited
22 SOTILLO RAFFY ILIGAN E/Cadet FILIPINO ### DUMARAO CAPIZ 22.05.2024 01.12.2020 unlimited
23 CABARDO BRENT AXEL CARVAJAL E/Cadet FILIPINO ### BOLINAO PGN 19.05.2024 06.05.2022 unlimited
25 #NAME? #NAME? #NAME? #NAME? ### #NAME? #NAME? #NAME? #NAME? unlimited
26 #NAME? #NAME? #NAME? #NAME? ### #NAME? #NAME? #NAME? #NAME? unlimited
14 NAVARRO JOHN MICHAEL SENORIN O/S 300.00 NIL 2000 PESO; 600 TLR
18252 9106
11. Position of the ship in the port (berth or station)
12. Brief particulars of voyage (previous and subsequend ports of call, underline where remaining cargo will be discharged)
IMO Convention on Facilitation of Ingternational Maritime Traffic
KLAIPEDA, ROTTERDAM
GRANITE PRODUCTS, EQUIPMENT FOR CARBOARD MILL, DIESEL ENGINE GENERATOR, MAC GAS COOLER,
NEWLY HOT ROLLED STEEL PLATE, EMPTY AND NEW TANK CONTAINER
11
14. Number of crew (incl. master) 15.Number of passengers 16. Remarks
27 NIL
1 NIL
19. Crew List 20. Passenger List 21. The ship's requirements in terms of waste and residue reception
facilities
1 NIL
22. Crew's Effects Declaration* 23. Maritime Declaration of
Health *
1 1
12. Date and signature by master, authorized agent or officer
IMO FAL
* Only on arrival
Form 1
OWNER CASH DECLARATION
✘
Arrival Departure
Ships Name CallSign Port of arrival /departure Date
KRASZEWSKI 5LFJ7 NANJING / CHINA 13.10.2022
Nationality Last / Next port Voyage No.
1 USD 7799
2 EURO nil
3 OTHER CURRENCY nil
Date and Signature by the MASTER
Master
----------------------------
EPIDEMIC CORONO VIRUS CHECKING - IMO CREW LIST
Ship Name Last Port Date
MV WLADYSLAW ORKAN NANTONG / PRC 9/24/2020
Flag - Registry Number Arrival Port IMO
MALTA / 9271925 SINGAPORE 9271925
No SURNAME NAME MIDDLE NAME Nationality Rank on board date and place of joining PP No PP Expire DatePresent body temperature (Celcius)
1 KIDA CEZARY 0 POLISH Master 7/30/2022 HAYDARPASA FA0627444 23.05.2032 36.4
2 SHOVA DMYTRO 0 UKRAINE Chief off. 8/10/2022 KOPER FK893942 15.01.2028 36.8
3 GANANCIAL SYDNEY DIMZON FILIPINO 2nd Off. 28.09.2022 SINGAPORE P7158288B 07.07.2031 36.7
4 NAUMENKO DANYIL 0 UKRAINE 3rd Off. 7/26/2022 HAYDARPASA FZ669776 09.12.2030 36.8
5 CYGANIK SEBASTIAN MARIUSZ POLISH Ch.Eng. 7/30/2022 HAYDARPASA EK5008551 08.04.2026 36.7
6 KWIATKOWSKI SYLWESTER POLISH 2nd Eng. 8/31/2022 SUEZ EU0304124 12.05.2031 36.8
7 OPLIMO KURT CAMELLO FILIPINO 3rd Eng. 2/8/2022 VITORIA P7208313A 16.05.2028 36.7
8 KRZEMINSKI WOJCIECH JAN POLISH Electrician 24.08.2022 BURGAS EK5819407 20.10.2026 36.6
9 #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 36.4
10 MIRASOL EFREN FRIOLO FILIPINO Boatswain 7/13/2022 SUEZ P2279958B 23.05.2029 36.4
11 #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 36.8
12 ABENIDO ELFIE EBERO FILIPINO A/B 28.09.2022 SINGAPORE P9905060B 03.05.2032 36.6
13 ENERO CORCINE JR ESTOCE FILIPINO A/B 28.09.2022 SINGAPORE P6970875B 11.06.2031 36.6
14 NAVARRO JOHN MICHAEL SENORIN FILIPINO O/S 28.09.2022 SINGAPORE P6138861B 20.01.2031 36.5
15 MONTANEZ RENATO JR UMANGAY FILIPINO O/S 7/13/2022 SUEZ P5566174A 09.01.2028 36.6
16 GABRIEL PHILIP DALO FILIPINO Storekeep. 6/3/2022 MASAN P5810744A 28.01.2028 36.8
17 TABBU JAN KENNETH GUINTU FILIPINO Motorman 7/13/2022 SUEZ P5422647B 19.08.2030 36.6
18 SHTEFAN OLEKSII 0 UKRAINE Cook 11.08.2022 KOPER FN394068 18.04.2028 36.6
19 AYCO FREDIMARK PEPITO FILIPINO Steward 7/13/2022 SUEZ P7154800B 07.07.2031 36.6
20 DIONGSON STEPHEN SANTILLAN FILIPINO D/Cadet 7/13/2022 SUEZ P8601143B 29.12.2031 36.4
21 SALAC ARTURO JR. MARQUEZ FILIPINO D/Cadet 7/13/2022 SUEZ P0466276C 09.06.2032 36.5
22 SOTILLO RAFFY ILIGAN FILIPINO E/Cadet 7/13/2022 SUEZ P6423765A 14.03.2028 36.8
23 CABARDO BRENT AXEL CARVAJAL FILIPINO E/Cadet 7/13/2022 SUEZ P9616824A 19.11.2028
24 0 0 0 0 0 12/30/1899 00 30.12.1899 36.6
25 #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME?
Sign & Stamp