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*. PERSONAL DETAILS

Surname SAMAL First Name :SARADA Middle Name :PRASANNA

Nationality :INDIAN Date of Birth :19/07/1992 Place of Birth :KURUJANGA

Post Applied for : Trainee Marine Engineer

Permanent Address :AT-MANTRIPADA, Present Address : AT-MANTRIPADA,

PO-FAKIRABAD, DIST-KENDRAPARA, ORISSA PO-FAKIRABAD, DIST-KENDRAPARA, ORISSA

PIN Code:754250 Nearest Airport :BIJU PIN Code:754250

PATNAIK AIRPORT,BBSR

Tel No / Mobile No:084******** Tel No / Mobile No:084********

,077******** ,077********

Email ID: aceu58@r.postjobfree.com

2. PASSPORT DETAILS

Passport No. Date of Place of Issue Date of Exp. ECNR Blank Pages

Issue

K5482664 PUNE NO 36

22/10/2012 21/10/2022

3. CONTINUOUS DISCHARGE CERTIFICATE /INDOS

Seaman's Number Date of Issue Place of Expiry Date Remark

Book (CDC) Issue

MUM224412 15/10/2013 MUMBAI

INDIAN 14/10/2023

INDOS 10EL1543 MUMBAI

30/04/2010

4. FAMILY INFORMATION

Full Name of Next of Kin :DHANESWAR SAMAL Relationship :FATHER

Address of Next of Kin :SAME AS ABOVE

Tel No. :+919*********

Family Data Name Contact Number/e-mail ID

Father DHANESWAR SAMAL +919*********

Mother BIDYUTLATA ROUT +919*********

D.SHANTI BASUDHA SAMAL +917*********

Brother/Sist

er

5. ACADEMIC QUALIFICATION

QUALIFICATION

YEAR OF PASSING PERCENTAGE BOARD/UNIVERSITY

B.TECH MARINE 2013 67.75 Y.C.M.O.U

H.S.C. 2009 68.5 ORISSA

BOARD

S.S.C. 2007 84.67 ORISSA

BOARD

6. STCW AND OTHER CERTIFICATES

Number Dt. Of Dt. Of Pl. of Issued by

Details of Courses Issue Expiry Issue

& Certificates

Advanced / Basic FPFF0801218280 18/07/201 KOLKATA MMA,KOLKATA

Fire Fighting 2

Proficiency in PST0561210566 KOLKATA MMA,KOLKATA

Survival Craft / 21/07/201

Rescue Boat / PST 2

/ PSC RB Up

gradation

Elementary / EFA0451212548 14/07/201 KOLKATA MMA,KOLKATA

Medical First Aid 2

/ Medicare

Personal Safety & PSSR0481212611 25/07/201 KOLKATA MMA,KOLKATA

Social 2

Responsibility

(PSSR)

Petroleum Tanker SMI/OTF/9266/2013 06/09/201 MUMBAI SMI, MUMBAI

Familiarization 3

Gas Tanker LGTF/4148/2013-14 14/09/201 MUMBAI OERC,MUMBAI

Familiarization 3

Ship MANET/STSDSD/062/201 19/08/201 PUNE MANET,PUNE

security(STSDSD) 3 3

7. Dangerous Cargo Endorsements

Grade / Number Date of Place of Date Of

Dangerous Cargo Level Issue Issue Expiry

Endorsements I / II

Oil Tanker Level DCE/T/EO/MMD/KOL/1265 28/11/201 KOLKATA

Familiarization 1 6 3 31/12/2016

Gas Tanker Level DCE/T/EO/MMD/KOL/1266 28/112013 KOLKATA

Familiarization 1 2 31/12/2016

8. YELLOW FEVER VACCINATION

Sr. No. Date Validity

10

17764 23/09/2013 years

9. DECLARATION

I hereby affirm that all the information provided by me in this application is

true and correct to the best of my knowledge and belief; further, that no

Certificate issued to me has ever been Revoked or Suspended.

Date Name

Signature

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MIT GROUP OF INSTITUTIONS PUNE

MAHARASHTRA ACADEMY OF NAVAL EDUCATION

& TRAINING [MANET]

Gat No.140, Loni-Kalbhor, Rajbaug, Pune-Solapur Highway,

Pune-412201.

Contact this candidate