Application form / personal data

Family Name: Lebedev

Name: Nikolay

Father’s Name: Vasiliy

Mother’s Name: Elena

Wife’s Maiden Name:

Date of Birth: 25/06/1988

Place of Birth / City & Country: USSR

Citizenship: Russia

Height: 185

Weight: 90

Colour of eyes: Blue

Colour of hair: Blonde

Permanent address:

Phone (home): +4012588394

50-5, Stekolnaya str., Kaliningrad, Russia

Phone (business): +79114691773

e-mail: nick_888.88@mail.ru Skype ID:

married single x divorced

Wedding date:

Next of kin (name, surname, kinship):

Address next of kin:

Nr. of Children:

Phone:

Nearest airport: Khrabrovo

Religion:

Waist: (cm)

Chest: (cm)

Shoe size:

Collar: (cm)

POSITION APPLIED FOR:

SEA SERVICE: