RANK APPLIED FOR: GP RATING (DECK)
*.PERSONAL PARTICULARS:
Name
First Name
Middle Name
Last Name
PRIYADARSHAN
BARUA
Date Of Birth
Place Of Birth
Sex
Nationality
INDOS No.
KOLKATA
MALE
INDIAN
15GL4450
Contact Address
Permanent Address
M-18/4 PAHARPUR ROAD KOLKATA-24
M-18/4 PAHARPUR ROAD KOLKATA-24
Height (cms)
Weight (Kgs)
Color of Eye
Color of Hair
173
65
BLACK
BLACK
2.NEXT OF KIN :
Name
First Name
Middle Name
Last Name
AMIT
KUMAR
BARUA
Contact Address
Relation
M-18/4 PAHARPUR ROAD KOLKATA-24
FATHER
3. DETAILS OF PASSPORT:
Number
Place Of Issue
Date Of Issue
Date of Expiry
Issuing Country
N0890615
KOLKATA
30/06/2015
29/06/2025
INDIA
4. DETAILS OF SEAMAN’S BOOK
Number
Place Of Issue
Date Of Issue
Date of Expiry
Issuing Country
KOL 105520
KOLKATA
28/07/2016
27/07/2026
INDIA
5. DETAILS OF VISA:
Type
Number
Place Of Issue
Date Of Issue
Date of Expiry
6. Y.F VACCINATION :
TYPE
DATE OF ISSUE
DATE OF EXPIRY
PLACE OF ISSUE
International certificate of vaccination (YELLOW FEVER)
01 September 2016
01 September 2026
KOLKATA
7. STCW’95 COURSES:
Year
Course
Institute/University/Issuing Authority
Certificate No
Date of Issue
Place of Issue
2015
EFA
TRIDENT COLLEGE OF MARINE TECHNOLOGY
TCMTEFA154019
07/07/2015
INDIA
2015
PST
TRIDENT COLLEGE OF MARINE TECHNOLOGY
TCMTPST154004
04/08/2015
INDIA
2015
FPFF
MERCANTILE MARINE ACADEMY
FPFF0531522579
19/08/2015
INDIA
2015
PSSR
TRIDENT COLLEGE OF MARINE TECHNOLOGY
TCMTPSSR154187
31/08/2015
INDIA
2015
STSDSD
TRIDENT COLLEGE OF MARINE TECHNOLOGY
TCMTSTSDSD15942
11/07/2015
INDIA
2015
OTF
TRIDENT COLLEGE OF MARINE TECHNOLOGY
TCMTOTF153014
11/09/2015
INDIA
9. MARITIME COURSE DETAILS:
Course
Program
Academy
Percentage of Marks Obtain
Certificate No.
Date of Passing
Year of Pass
GP RATING
TRIDENT COLLEGE OF MARINE TECHNOLOGY
A (ABOVE 80% MARKS)
G1512K05074/DEC 15/48501
28/01/2016
2016
10.
OTHER QUALIFICATION:
Course
Subject Studied
11. Well performance in Quiz, GK, debate and other Curricular activities.
I hereby declare that the above furnished details are true and correct to the best of my knowledge and belief.
Date:
Place: KOLKATA Signature