FP1802 Crew Data Form

Hire Date MAPS ID

(month) (day) (year)
NAME Molinar Moises Dept
(last) (first) Position
Onboard/Ship
Address 21, Don Carlos, Dolega, Dolega, Chiriquí, Panamá
Home Airport Tocumen, Panama

City Dolega Postal Code N/A Marital Status ✔

Country Panamá Single Married Divorced Widowed Separated

Phone # (507) 6001-7914 Sex ✔

(country code), (city code), # Male Female
Email moises.molinar@umip.ac.pa Personal Attributes Black brown 177cm 79kg
(hair) (eyes) (height) (weight)
SS# (US Only)
Date of Birth 08 21 1999
ARC # (month) (day) (year)
Birthplace David, Chiriquí, Panamá
Citizenship / Country Panamenian / Panama

Passport # PA0964970 Passport Issue Date 11 14 2022

(month) (day) (year)
Passport Country / City of Issue Panama / Panama City Passport Expiry Date 11 14 2027
(month) (day) (year)
Second Passport # 2nd Passport Issue Date
(month) (day) (year)
2nd Passport Country/City of Issue 2nd Passport Expiry Date
(month) (day) (year)
Seaman’s Book # PA0371925 Seaman’s Book Issue Date 03 07 2023
(month) (day) (year)
Seaman’s Book Country / City of Issue Panama / Panama City Seaman’s Book Expiry Date 02 28 2028
(month) (day) (year)
C1D Visa # U0520834 C1D Visa Expiry Date 05 29 2028
(month) (day) (year)
Date of last Physical Exam
(month) (day) (year)
Languages(Other than English) Spanish ( Native)

Emergency Contact Dependant Information

Name Ricardo Molinar Almanza Name Date of Birth

Relationship Father N/A

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N/A
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Address 21, Don Carlos, Dolega, Dolega, Chiriqui, Panamá

City/State Dolega
Country Panama
Phone # (507) 776-1553
Mobile # (507) 6001-7914

Sign off Date

(month) (day) (year) Signature