AGILE MARITIME RESOURCES INC.

APPLICATION FORM & PERSONAL DATA SHEET

DATE 09/13/2018 __POSITION APPLIED: 3/0 ALTERNATE POSITION: 4/0

PERSONAL DETAILS
Last name VIGO First name CLOYD CLEVENSE Middle name GARROVILLO
Date of birth 05/10/1990 Place of birth ILOILO CITY Age 28
09494969724/0947504784
Present contact address MARINGYAN MIAGAO ILOILO Telephone
5
Provincial address (If any) MARINGYAN MIAGAO, ILOILO PROVINCE Mobile Number 09494969724
Sex M Weight 70 kgs Height 1167 cm Shoe size 9 Cover all M Waistline 32
Religion
FAMILY BACKGROUND
Name of Father SSMUEL Z. VIGO Name of Mother JOYCE G. VIGO
Status Single Name of spouse N/a Date of birth N/a
Occupation of spouse Name of company
Office address Telephone
Children and/or other dependent’s name (If single; Mother and Father) Date of Birth Relationship
JOYCE G. VIGO 04/06/1970 MOTHER
CHARLE VIELLE VIGO 06/29/1994 BROTHER

EDUCATIONAL ATTAINMENT
BACHELOR OF SCIENCE IN
Highest educational attainment COLLEGE Degree obtained MARITIME
TRANSPORTATION
Name of school JOHN B. LACSON MARITIME UNIVERSITY Year graduated 2009
SHIPBOARD EMPLOYMENT DOCUMENTS
Number Date issued Validity
Passport Place issued: DFA Manila P5092813A 20 NOV. 2017 19 NOV 2022
Seaman’s book Place issued: Iloilo CO227354 10 JUN. 2014 09 JUN. 2019
SRC Rank: 2/0 IL3794609 22 FEB. 2017
US Visa Place issued: MANILA R C1/D 10 JAN. 2018 04 JAN. 2023
GOC certificate Place issued: ILOILO GO10061500212 25 JUN. 2015 24 JUN. 2020
PRC certificate Rank: OIC-NW D3-0081025 04 AUG. 2014 10 MAY 2019
PRC endorsement Level: OPERATIONAL 4256352 27 JUL. 2017 27 FEB. 2022
TESDA COC Marks:
TRAINING CERTIFICATES
DATE NAC CERTIFICATE
TRAINING COURSE CERTIFICATE NUMBER
ISSUED NUMBER
34 JUN.
BASIC SAFETY COURSE W/ PSSR (BSC W/ PSSR) BT140606139 24116072
2014
28 MAY
PROFICIENCY IN SURVIVAL CRAFT AND RESCUE BOAT (PSCRB) SC38051500783 15305087B
2015
14 OCT.
MEDICAL EMERGENCY FIRST AID (MEFA) MEFA11100066 18131794
2011
01 JUL.
GENERAL TANKER FAMILIARIZATION (GTF) BTOC140700043 2315775
2014
SHORE BASED FIRE FIGHTING (SBFF)
28 OCT.
INERT GAS SYSTEM / CRUDE OIL WASHING (IGS/COW) C/IGS111002774
2011
10 JUN.
MARITIME SECURITY (SHIP SECURITY AWARENESS) 2014SATSDSD3262 2723585
2014
RATINGS FORMING PART OF ENGINEERING WATCH (EW)
PREVENTION OF ALCOHOL AND DRUG ABUSE IN THE MARITIME
SECTOR PADAMS)
DANGEROUS HAZARDOUS AND HARMFUL CARGOES (DHHC)
13 JAN
MARPOL 73/78 ANNEX II ILOM1/6170041
2017
13 JAN.
MARPOL 73/78 ANNEX I ILOM1/6170041
2017
INTERNATIONAL SAFETY MANAGEMENT (ISM)
MARITIME ENGLISH FOR RATINGS (ME)
Yellow Fever (expiration date) LIFETME
SSS number N/A TIN number (if any) N/A PhilHealth number (if any) N/A
 NAME CLOYD CLEVENSE VIGO POSITION:_4/0______
SEA SERVICE
Salary Nationality of
Embarked Disembarked Trade route (deck) Type of Reason for Name of Local
Name of vessel Rank GRT Flag All in Master (Deck)
DD/MM/YY DD/MM/YY Main Engine (eng) Vessel Leaving Principal Agency
US$ C/Eng (Eng)
EVIC
AMAZON LIVANO
A/B 26/02/18 09/09/18 40075 WORLWIDE CRUDE NASSAU 1800 F/C HUMAN GREEK
BRILLIANCE
RESOURCES
CHANGE EVIC
LIVANO
MT CHIOS A/B 10/03/17 25/07/17 81315 WORLWIDE CRUDE NASSAU 1800 MANAGE HUMAN GREEK
MENT RESOURCES
EVIC
03/02/17430 CHANGE LIVANO
AMAZON GUARDIAN A/B 17/01/17 43075 WORLWIDE CRUDE CHIOS 1800 HUMHUMAN GREEK
75 VESSEL
RESRESOURCS
FOREIGN LICENSES SEAMAN’S BOOK AND CERTIFICATES ALLOTMENT DETAILS
Country Document Number Date issued Validity Capacity or Rank First allotee Second allotee
Name of allotee JOYCE G. VIGO CLOYD CLEVENSE VIGO
Relationship MOTHER SELF
MARINGYAN MIAGAO MARINGYAN MIAGAO
Address
ILOILO ILOILO
Telephone number 09494969724 09494969724
Amount
BPI SOLIS COR IZNART ST BPI SOLIS COR IZNART
Bank branch
ILOILO CITY SST. ILOILO CITY
Account no. 0139118014 9249396548
IN CASE OF EMERGENCY PLEASE NOTIFY (Name, address telephone number) REFERENCES AND GUARANTORS
(Name address/company, tel.)
JOYC G. VIGO/MARINGYAN MIAGAO ILOILO/09494969724/09070590144
BENEFCIARY
Name JOYCE G. VIGO Relationship MOTHER Address MARINGYAN MIAGAO ILOILO Telephone 09070590144

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