APPLICATION FOR ENGINE ROOM FITTER

Surname: HEWA PATHIRANA First Name: SIDATH ANUSHKA

Nationality: Sri Lankan Date of Birth: Age: 23 Place of

01.03.1987 Birth:

Colombo

Passport

Number Place of Date of Date of Issuing Authority

Issue Issue Expiry

N2671801 Colombo 09.08.2010 09.08.2020 Immigration &

Emigration

Authority, Sri

Lanka

Seaman's Book (CDC)

Number Place of Date of Issuing Date of

Issue Issue Authority Expiry

C036062 Shipping 09/08/2010 Merchant 07/10/2015

Office, Shipping

Colombo Division,

Colombo,

Sri Lanka.

Medical Fitness Certificate

Date of Issue Date of Expiry

Full address: 134/A, ALAKESHWARA ROAD, ETUL KOTTE, KOTTE

Postal Code: 11010

Country: Sri Lanka

E-mail id: abifbf@r.postjobfree.com

Home telephone no: 009**********

Contact/Mobile phone: 009**********

Domestic Airport: N/A International Airport: Colombo

Marital Status: Single

Certificate of Competency (COC)

Certificate of proficiency as skilled craftsman in the trade of FITTER

(GENERAL)

Four years full time course conducted by NAITA.

(01st Aug 2006 to 31st July 2010)

Details of other marine courses / STCW short course certificate

Type of Marine Place of Number Date of Date of

Course Issue Issue Expiry

Elementary Medical CINEC Campus SD-310/1782/10-54 **-**-**-**-**-**

First Aid Sri Lanka /0024

Fire Prevention & CINEC Campus SD-305/1768/10-51 **-**-**-**-**-**

Control Sri Lanka /0001

Personal Survival CINEC Campus SD-300/1751/10-45 **-**-**-**-**-**

Technique Sri Lanka /0002

Personal Safety and CINEC Campus SD-331/1819/10-37 20-08-10 N/A

Social Sri Lanka /0016

Responsibilities

Support Level CINEC Campus 816/1577/10-21/00 17-09-10 N/A

(English Course) Sri Lanka 06

Ship Security CINEC Campus SD-338/1835/10-15 24-09-10 N/A

Awareness Sri Lanka /0028

Other Personal Details

Height : 170cm Weight: 64 Kg

Colour of Eyes : Black Color of Hair: Black

Distinguishing Marks : N/A

Person to Contact In Case Of Emergency or Accident

Name: Mr. H. P. KARUNATHILAKE

Address: 134/A, ALAKESHWARA ROAD, ETUL KOTTE, KOTTE

Residential Contact: 009********** Mobile Contact: 009**********

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no Certificate of competency or License issued to me has ever been Revoked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: 08/08/2010

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