APPLICATION FORM

PERSONAL DATA

Surname: MONDAL

Middle Name: KUMAR

First Name: BIKASH

Nationality: INDIAN

Date of Birth: 05-09-1965

Place of Birth: BARASAT

Post Applied for:2nd Engineer

Willing to Accept Lower Rank? Yes / No: NO

Available from: ( 23 /02 / 2018 )

Permanent Address:

Present Address:

TULSI BAGAN, P.O.: BIRATI, KOLKATA,

W.B., PIN Code: 700051

SAME AS PERMANENT ADDRESS

Tel No / Mobile No.: 983-***-****

Tel No / Mobile No.:

Email ID : ac5u55@r.postjobfree.com

Passport No.

Date of issue

Place of Issue

Date of Exp.

ECNR

Blank Pages

K0477215

30-03-2012

KOLKATA

29-03-2022

ECNR

33

US VISA

MCV TRN No

MUI M’ship#

Australian MCV

Seaman’s Book(CDC)

Number

Date of Issue

Place of Issue

Expiry Date

Remark

Indian

BY67324

09-10-1992

MUMBAI

23-04-2025

Liberian

Others

INDOS

00EL1590

LBS, MUMBAI

Licence

Grade

Number

Date of Issue

Pl. Of Issue

Expiry Date

Indian

CLASS IV

95Z-0274

21-12-2015

KOLKATA

06-11-2020

Liberian

Panamanian

UK

Others HONDURAS

Class 2

RH-A No 043021

22-02-2018

Honduras

22-02-2022

Civil Status : Single / Married / Separated / Divorced / Widowed

MARRIED

Full Name of Next of Kin : MRS. POLY MONDAL

Relationship : WIFE

Address of Next of Kin : SAME PERMANENT ADDRESS

Tel. No. : 086********

Family Data

Name

DOB

PPT No.

DOI

Place of Issue

DOE

ECNR

Wife

MRS. POLY MONDAL

21-01-1969

Child M/F

MS. TIYASA MONDAL

13-04-2000

Child M/F

MS. DISHA MONDAL

12-12-2013

Details of Courses & Certificates

Number

Dt. Of Issue

Dt. Of Expiry

Pl. Of Issue

Issued by

Advance/Basic Fire Fighting

00190

26-11-13

25-11-2018

KOLKATA

IMU KOLKATA

Proficiency in Survival Craft/Rescue Boat/PST/PSC RB Upgradation

00178

16-11-2013

15-11-2018

KOLKATA

IMU KOLKATA

Elementary/Medical First Aid/Medicare

0048

18-11-2013

17-11-2018

KOLKATA

IMU KOLKATA

Personal Safety &Social Responsibility (PSSR)

02712

12-02-2015

KOLKATA

IMU KOLKATA

Ship Security Officer Course

02668

09-11-2013

KOLKATA

IMU KOLKATA

Radar Observer / ROP

ARPA

Radar Simulator (RANSCO)

LCHS Management/Operational

High Voltage Safety and Switch Gear Course

SMCC/HVO/449

03-04-2017

KOLKATA

SEACOM MARINE COLLEGE

TASCO

KOL/TASCO/11-17/08

17/11/2017

KOLKATA

SEI Educational Trust,KOL

GMDSS

Petroleum Tanker Safety

Chemical /Gas Tanker Safety

Petroleum Tanker Fam.

Chem/Gas Tanker Fam.

Ship Manoeuvring Simulator

ECDIS

Bridge Team Management

Bridge Resource Mgt.

Eng Room Resou Mgt.

Eng Room Team Mgt.

Eng Room Simulator

Dangerous Cargo Endorsements

Grade/ Level I/II

Number

Date of Issue

Place of Issue

Dt. Of Exp.

OIL TANKER

I

DCE01KOL17001233

23/11/17

KOLKATA

22/11/2022

Pre Sea Training / Apprenticeship

Name of Institute / College

HINDUSTANSHIPYARD LTD., VIJAG

From

05-08-1991

To

04-08-1992

Type of Degree

I hereby afirm that all the information provided by me in this application is true and correct tothe best of my knowledge and belief, that no Certificate of competency or licence issued to me has ever been Revoked or Suspended.

Date 23/02/2018 Rank 3E

Previous Sea Service ( Date Commencing from Last Vessel)

Sr. No.

Name of Owners / Managers

Name of Vessel

Rank

Flag

Type

DWT

GRT

BHP

Engine Type

UMS

Y/N

From

To

Total

MM/DD

Reason

for S/Off

1

OESM/TWSM

M.V. SSL BHARAT

3E

IND

CONTAINER

34704

29383

30560

MAN B&W 8S 70MC

N

06-07-2017

26-01-2017

06/21

2

APJ SHIPPING LTD.

MV APJ KAIS

3E

IND

BLK

32957

9480

MAN B&W 6S50MC-C

N

19-02-2016

19-04-2016

02

3

OESM

MV SSL SAGARMALA

3E

IND

CONTAINER

9336

6942

6820

MAN B&W6L42MC

N

17-04-2015

15-10-2015

05/29

4

OESM

MV OEL BENGAL

3E

S’PORE

CONTAINER

14910

10676

8340

MAN B&W50MC

N

18-06-2014

01-01-2015

06/14

5

OESM

MV OEL KOCHI

3E

IND

CONTAINER

24553

21339

16680

MAN B&W

6S60MC

Y

01-08-12

31-01-13

06/00

6

OESM

MV JINDAL KAMLA

2E

IND

GC/

CONTAINER

5847

2480

MWM-AG TBD510BL8

N

29-05-11

15-09-11

03/17

7

BSM

MV PACIFIC RUBY

3E

HONG KONG

VLOC

254095

147902

25181

MAN B&W

7L90MC

Y

29-11-09

02-05-10

05/04

8

ESM

MT LYRA PIONEER

3E

PANAMA

OILP

45985

28059

12890

MAN B&W

6S50MCC

N

20-12-08

14-06-09

05/24

9

ESM

MV VANDA

COLOSSUS

3E

S’PORE

BLK

55863

30882

8200

MAN B&W

6S50MCC

Y

03-03-08

15-09-08

06/12

10

ESM

MV MOKARA

COLOSSUS

3E

S’PORE

BLK

55781

30807

8200

MAN B&W

6S50MCC

Y

28-11-06

11-07-07

08/13

11

ESM

MT PACIFIC

OASIS

3E

PANAMA

OILP

28799

12899

MAN B&W

6S50MCC

N

05-02-06

30-06-06

04/26

12

FML

MT DEVSI

3E

IND

TANKER

52629

14700

B&W

6L70MCE

N

24-12-04

13-08-05

07/19

13

FML

MV MIN NOBLE

3E

PANAMA

BLK

65785

35671

14400

SULZER

6RND76M

N

08-07-03

10-02-04

07/02

14

FML

MV NEW ERA

3E

HONG KONG

BLK

17590

10303

MITSUBISHI

5EUC52LS

N

06-07-01

17-01-02

06/01

15

SCI

MV DEV PRAYAG

3E

IND

BLK

28739

10800

B&W

6L60MCE

N

11-08-98

14-07-99

11/03

16

SCI

MT

CV RAMAN

3E

IND

TANKER

25040

9900

SULZER

6RND68

N

16-05-96

06-02-97

08/20

17

SCI

MV HARGOBIND

4E

IND

BLK

23339

13100

B&W

7K74EF

N

02-05-94

13-05-95

13/11

18

SCI

MV VISVA

SHOBHA

5E

IND

GC

9337

9000

SULZER

6RD76

N

14-10-92

12-11-93

12/28

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