Application Form

PERSONAL DATA

NAME:AKHIL Date of Birth : 03/02/1988 Place of Birth: TRIVANDRUM,

RAMACHANDRAN NAIR KERALA

Nationality :INDIAN Post Applied for : 4TH INDOS NO:11EL1880

ENGINEER

Permanent Address : Present Address :

AISWARYA KUNNOORSALA ROAD AISWARYA KUNNOORSALA ROAD

KACHANI KARAKULAM PO KACHANI KARAKULAM PO

THIRUVANANTHAPURAM THIRUVANANTHAPURAM

Nearest Airport:Trivandrum

PIN Code :695564 PIN Code : 695564

KERALA

Tel No / Mobile No:085******** Alt Tel No / Mobile No:095********

Email ID :acrh5x@r.postjobfree.com

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

Issue

J2307771 22/09/2010 TRIVANDRUM 21/09/2020

Seamans Number Date of Issue Place of Expiry Date Remark

Book (CDC) Issue

INDIAN 01/12/2011 MUMBAI 01/12/2021

MUM 195589

Single

Civil Status :

Relationship :FATHER

Full Name of Next of Kin :RAMACHANDRAN NAIR M

Address of Next of Kin:AISWARYA KUNNOORSALA ROAD KACHANI KARAKULAM PO

THIRIVANANTHAPURAM, KERALA

Tel No. :094********

Application Form

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

Courses & Issue Expiry

Certificates

Basic Fire

SIMS/LNV/FPFF/011/2011/200 03/08/2011 LONAVALA SIMS,LNV

Fighting

Personal

Survival SIMS/LNV/PST/010/2011/180 30/07/2011 LONAVALA SIMS,LNV

Techniques

Elementary First

SIMS/LNV/EFA/012/2011/219 06/08/2011 LONAVALA SIMS,LNV

Aid

Personal Safety

& Social

SIMS/LNV/PSSR/009/2011/159 27/07/2011 LONAVALA SIMS,LNV

Responsibility

(PSSR)

Medical First Aid MFA/EMA/305-13/004574 07/03/2013 COCHIN EUROTECH

Proficiency in

Survival Craft / PSCRB/EMA/190-13/003224 23/02/2013 COCHIN EUROTECH

Rescue Boat

Advanced Fire

AFF/EMA/293-13/004417 02/03/2013 COCHIN EUROTECH

Fighting

Engine Room

SIMS/LNV/ERS(0)/01/2012-02 18/01/2012 LONAVALA SIMS,LNV

Simulator

Petroleum

Tanker SIMS/LNV/OTFC/IV/2012/02 30/03/2012 LONAVALA SIMS,LNV

Familiarisation

Chemical Tanker

SIMS/LNV/CTFC/III/2012/02 24/03/2012 LONAVALA SIMS,LNV

Familiarisation

Dangerous Cargo Grade / Number Date of Place of Date Of

Endorsements Level Issue Issue Expiry

I / II

LEVEL 1 DCE/OT/KOC/E- 16/06/2015 KOCHI 01/03/2018

OIL TANKER

(operational) 131/15

LEVEL DCE/CT/KOC/E- 16/06/2015 KOCHI 01/03/2018

CHEMICAL TANKER

1(operational 080/15

)

PreSea Training / Apprentice Ship

Name of Institute / College From To Type of Degree

SAMUNDRA INSTITUTE 01/03/2011 29/02/2012 GME

OF MARITIME STUDIES

COC DETAILS

NO ISSUE PLACE ISSUE DATE VALID TILL

95Z-20018 MUMBAI 20/05/2015 03/02/2020

Application Form

US VISA AND YELLOW FEAVER DETAILS

NO TYPE ISSUE PLACE ISSUE DATE EXPIRY DATE

F1564919 C1/D CHENNAI 27/04/2012 25/04/2017

L0T NO.088 YELLOW COCHIN 14/04/2012 03/04/2022

FEAVER

Previous Sea Service (Date Commencing from Last Vessel)

Tota

Name of

Sr. Engine UMS l Reason for

Owners / Name of Vessel Rank Flag Type DWT GRT BHP From To

No. Type Y/N MM S/OFF

Manager

/DD

EXECUTIVE PROD

MITSU

SHIP M.T..LR2 HONG UCT 1,15,27 13560 25/07/2 15/02/2 CONTRACT

1 J/E 59172 MAN- Y 202

MANAGEMEN PIONEER KONG TANKE 3 MT KW 012 013 COMPLETED

B$W

T R

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 of competency or License issued to

me has ever been Revoked or Suspended.

Date 18/06/2015

AKHIL RAMACHANDRAN NAIR

095********

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