AZUREUS OFFSHORE TRAINING

Start your next chapter offshore.

Complete your course registration with the details below.

01 Personal details02 Documents03 Photograph

Application form

Please enter your details as shown on your official documents. Fields marked * are required.

Personal & course details

Course

FULL NAME

DATE OF BIRTH

PLACE OF BIRTH

NATIONALITY

HOME TELEPHONE

MOBILE PHONE 1

MOBILE PHONE 2

EMAIL 1

EMAIL 2

ADDRESS (Permanent Residential Address)

POST CODE

STATE

COMPANY

CURRENT RANK ON BOARD

Passport

PASSPORT NUMBER

PLACE OF ISSUE

DATE OF ISSUE

VALID UNTIL

ID CARD (for indonesian only)

Seaman Book

SEAMAN BOOK NUMBER

PLACE OF ISSUE (Seaman Book)

DATE OF ISSUE (Seaman Book)

VALID UNTIL (Seaman Book)

Certificate of
Competency (COC)

CERTIFICATE OF COMPETENCY (COC) NUMBER

GRADE