(Passport Photo)

SEAFARER'S APPLICATION FORM -PERSONAL DATA Page 1 of 3 -

POST APPLIED 2/ENGINEER

PERSONAL INFORMATION

Family Name

SHIKIDAS

First Name (s)

ERAVELI THANKAPPAN

Birth Date

**-*2-1968

Birth Place

COCHIN

Nationality

INDIAN

Religion

HINDU

Marital Status

MARRIED

No. of Children

ONE

Height (cm)

178

Weight (kg)

80

Nearest Airport

KOCHIN AIRPORT

Alternative Airport

MUMBAI

ADDRESS (include telephone country & area codes, advise also secondary or contact addresses if any)

Street & Nr.

VAZHAKALA

Email Address

ac0vpr@r.postjobfree.com

Location

KAKKANAD

Mobile Phone

+919*********

City

ERNAKULAM

Residence Phone

+919*********

State, Country

KERALA,INDIA

Fax

N.A

Postal (ZIP) Code

682030

P.O. Box (if any)

VAZHAKALA POST

NEXT OF KIN INFORMATION (person to contact in case of emergency & insurance beneficiary)

Family Name

SREEJA SHIKIDAS

First Name(s)

KOLLIYAMPARAMBIL RAVEENDRAN

Nationality

INDIAN

Relationship

WIFE

Street & Nr.

SAME ASABOVE

Email Address

ac0vpr@r.postjobfree.com

Location

KAKKANAD

Mobile Phone

+919*********

City

ERNAKULAM

Residence Phone

+918********

State, Country

KERALA,INDIA

Fax

Postal (ZIP) Code

682030

P.O. Box (if any)

SAME

REMARKS

Requested Rank

3/ENGINEER/OR 2ND

Availability Date

ANYTIME

Prefer. Vessel Type,BULK CARRIER,BITUMEN TANKER,OFFSHOREVESSEL,TANKER,CONTAINER,

Minimum Salary

English Language Skills

Spoken: fluent / good / - Written: fluent / good /

Other Foreign Languages

HINDI,TAMIL.MALAYALAM

Professional School / Academy - Name & Period (From - To)

DIPLOMA,POLYTECHKOTTYAM

1987TO 1990

Foreign Crew Experience

(specify nationalities)

UKRAINE,RUSSIANS,NIGERIA,BURMIS FRANCE,BULGERIA,BANGLADESH,INDONESIAN,SOUTHAFRICA

Other Skills

KNOW MECHANICAL JOBS VERY WELLFABRICATOR,WELDING,GASCUTTING,LATHE.

Further Remarks

Please advise how you heard about Vroon Shipping:

(underline appropriate option)

Newspaper / Advert/ Google / Internet / Relative / Other Seafarer School / University / Other sources …INTERNET

I hereby affirm that all the information provided by me in this application is true and correct to the best of my knowledge.

Date05--06-2017

Signature: SHIKIDAS ERAVELI THANKAPPAN

Note: This form can be returned per email without signature - please ensure however to send a signed printout for our records afterwards per mail (e.g. with the passport photos and photo copies required). Please sign all 3 pages of the application form separately.

SEAFARER'S APPLICATION FORM - Page 2 of 3 - LIST OF DOCUMENTS

Please note that due to legal requirements employment is only possible once we are in possession of electronic copies of your documents and licenses (please refer to the Cover Letter for further instructions).

Family

Name

First

Name(s)

Rank

A. TRAVEL DOCUMENTS AND MEDICAL CERTIFICATES

Document Name (Description)

Document Number

Country

Issue Place

Issue Date

Exp. Date

Passport

P4130834

INDIA

KOCHIN

03-11-2016

02-11-2026

Seaman's Book (national)

MUM 98833

INDIA

MUMBAI

20-04-2012

19-04-2022

Seaman's Book (flag state)

P0188794

PANAMA

PANAMA

27-01-2017

25-01-2022

Seaman's Book (flag state)

26497

BELIZE

MUMBAI

03-13-2013

03-13-2018

Visa - United States (type C1/D)

EXPIRED

INDIA

MADRAS

30-05-2008

30-05-2013

Visa - Others (Work/Reside. Permits)

Medical Examination Report

FIT

INDIA

KOCHIN

APRIL

2016APRIL

Drug & Alcohol Test

FIT

20-05-2007

20-05-

Vaccination against Yellow Fever

4 F17/06

INDIA

KOCHIN

20-05-2007

20-05-2017

Vaccination against Cholera

N/A

Passport Photos

please email a high quality copy of a recent passport photo.

B. CERTIFICATES OF COMPETENCY & ENDORSEMENTS, COURSE CERTIFICATES

- Deck & engine certificates & endorsements (officers / ratings)

- electrical & reefer certificates

- cook & steward certificates

- radio certificates & endorsements

- safety training (surv., fire, medical)

- tanker courses (oil, chem., gas)

- passenger vsl, roro, hazmat courses

- nav., deck, technical & management

courses (radar/ARPA, ISM, Marpol,

Simulators, computer, welding etc.)

- any flag state certificates

Document Name (Description)

Document Number

Country

Issue Place

Issue Date

Exp. Date

PANAMA COC-2 ENGINEER

CT009658/17 111/1

PANAMA

PANAMA

27-01-2017

25-01-22

BELIZE COC-2/ENGINEER

CC-16727 111/2

BELIZE

MUMBAI

03-12-2013

03-12-2018

DCE.OTFC

M/O/1/E/1058395

INDIA

MUMBAI

27.07.2010

26-07-2015

DCE. CTFC

M/C/1/E/11/11981

INDIA

MUMBAI

14.10.2011

14-10-2016

A.F.F./F.P.F.F.

AFF/062/2004

INDIA

EURO TECH

26.07.2012

25-07-2022

P.S.T. / P.S.C.R.B.

PST/PSCRB

INDIA

EURO TECH

29.06.2012

28-09-2020

P.S.S.R.

PSSR753-12/12307

INDIA

EURO TECH

01.08.2012

01-08-2020

EF.A./M.F.A./MEDICARE

MFA0120170052010

INDIA

T.S.RAHAMAN

19.11.2015

01-05-2020

O.T.F.C. / TASCO

08/014/2011 TASCO/OTFC

INDIA

PENTAGON MARINE

26.08.2017

26-08-2022

C.T.F.C. / CHEMCO

CHEMO

INDIA

PENTAGON MARINE

22-09-2011

22-09-2018

PROFICIENCY SSO

SSO 440*********

INDIA

T.S.RAHAMAN

26.03.2010

26-03-2020

I.S.P.S.

ISPS

INDIA

RAIS INISTTIUTE

05.04.2005

05-04-2018

S.T.S.D.S.

STS/EMA/90

INDIA

EURO TECH

27.11.2013

27-11-2020

INDOS

DCE

01XL3034

PANAMA

Date 05-06 2017

Signature: SHIKIDAS ERAVELI THANKAPPAN

SEAFARER'S APPLICATION FORM - Page 3 of 3 - SEA SERVICE (LAST 10 YEARS)

.

Vessel's Name

IMO No.

Flag

GT

kW

Ship Type

Eng.Make

Rank

S/On Date

S/Off Date

Employer (company to contact for reference)

M.VPORTLAND

7413751

STKITTIS

25000

8000

BULK CARRIER

3 MAJ

SULZER

3/ENG

09-05-16

25-10-16

VERNEL MARITIME SERVICES

DELTA SKY

9579719

MARSHAL

1528

1961X 2

ANCHOR HANDLING

G/E TWIN

2/ENG

08-04-15

25-08-15

PRIME GULF INTERNATIONAL

BITUMEN TANKER

CLATON 11

9020467

PANAMA

2873

2386

BITUMEN TKR

AKASAKA

3/ENG

17-06-14

16-012-14

MARIAN MARINE

M.TOLIVIA-I

CHEMICAL TANKER

9053191

PANAMA

11423

6599

CHEMICAL TANKER

MAN B & W

3rd ENG

27.12.12

05.09.13

TRANS OCEAN

M.T.BLUE GREN TIGRE

CHEMICAL TANKER

9514494

MARSHAL

5083

2960

CHEMICAL TANKER

MAK/X9-M25

3thENG

22.10.11

26.05.12

PENTAGON MARINE

M.V.GLORY-1

BULK CARRIER

8010762

PANAMA

17770

8948

BULK

SULZER SR 76

3rd ENG

13.09.10

17.06.11

SSM SHIP

ANAHITA . CONT:

8413291

PANAMA

324285

12134

CONTAINER

B &W MITSUI

E/FITTER

10.05.09

26.12.09

MSC SHIP

SELIN CONT:

7822548

PANAMA

16795

2X8724

CONTAINER

SULZER 68

E/FITTER

10.08.08

19.01.09

MSC SHIP

KATHARNINE ANN

8300975

PANAMA

18700

11334

CONTAINER

SUL RTA 84

E/FITTER

06.07.07

10.04.08

MSC SHIP

SABRINA CONT:

8714205

PANAMA

35598

16107

CONTAINER

B &WMITSU

E/FITTER

07.06.06

02.03.07

MSC SHIP

HINA, CONT:

8331175

PANAMA

21370

7382

CONTAINER

SULZER

E/FITTER

17.04.05

12.01.06

MSC SHIP

M.V.ROSEWOOD/BL

7630740

PANAMA

13880

4474

BULK

PIESTICK

4thENG

17.04.05

12.01.06

TRISUL SHIP

MV.ELMWOOD BLK

8015644

PANAMA

10320

3825

BULK

PIESTICK

E/FITTER

16.07.02

02.03.03

TRISUL SHIP

MV.REDWOOD BLK

7831005

PANAMA

9760

3825

BULK

PIESTICK

4thENG

22.11.00

24.10.01

TRISUL SHIP

MV.MEGHANA BLK

8036604

PANAMA

13880

4475

BULK

PIESTICK

E/FITTER

14.04.98

06.05.99

TRISUL SHIP

Date: 05-06-2017

Signature: SHIKIDAS.E.T

Contact this candidate