*. PERSONAL DETAILS

Surname :YADAV First Name :VIVEK Middle Name :

Nationality :INDIAN Date of Birth :02/03/1996 Place of Birth :CHHINDWARA

Weight (kg) :67 Height (cm) :184 BMI :

Post Applied for : DECK CADET

PERMANENT ADDRESS-AT-Naulajhir PRESENT ADDRESS--AT-Naulajhir

Post-Chand,Teh-Chand,Dist-Chhindwara,MP Post-Chand,Teh-Chand,Dist-Chhindwara,MP

Pincode-480110 Pincode-480110

Nearest Airport-

2. PASSPORT DETAILS

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

Issue

P0121978 03/08/2016 BHOPAL 02/08/2026 32

3. CONTINUOUS DISCHARGE CERTIFICATE / INDOS

Seaman's Number Date of Issue Place of Expiry Date Remark

Book (CDC) Issue

Indian

INDOS 15NL0884 28/08/2015 MUMBAI

4. FAMILY INFORMATION

Full Name of Next of Kin :BANWARI LAL YADAV Relationship : FATHER

Address of Next of Kin-AT-Naulajhir Tel No. :845-***-****

Post-Chand,Teh-Chand,Dist-Chhindwara,MP.Pincode-480110

Family Data Name Occupation Contact Number/e-mail

ID

Father BANWARI LAL YADAV FARMER 845-***-****

Mother SANJU YADAV HOUSE WIFE 845-***-****

SHARAD YADAV STUDENT 975-***-****

Brother/Sis

ter

Any Relatives in Marine Field -NONE

5. ACADEMIC QUALIFICATION

QUALIFICATION

YEAR OF PERCENTAGE PCM BOARD / UNIVERSITY

PASSING PERCENTAGE

2018 78.5% MIT-ADT UNVERSITY

B.SC. NAUTICAL

SCIENCE

DIPLOMA

2014 79.3% 79.3% CBSE

H.S.C.

2012 79.8% CBSE

S.S.C.

6. DETAILS OF B.TECH (MARINE) COURSE:

PERCENTAGE AVERAGE %

SEMESTER

SEMESTER 1 85.6%

78.5%

SEMESTER 2 75.2%

SEMESTER 3 78.2%

SEMESTER 4 72.5%

SEMESTER 5 75.1%

SEMESTER 6 84.6%

7. STCW AND OTHER COURSES

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

Details of Issue Expiry Issue

Courses &

Certificates

FIRE PREVENTION FPFF0301724414 17/06/201 KOLKATA

AND FIRE FIGHTING 7 MERCANTILE

MARINE ACADEMY

PERSONAL SURVIVAL PST0241714623 24/06/201 KOLKATA MERCANTILE

TECHNIQUES 7 MARINE ACADEMY

Elementary / MANET/EFA/33/2016/00 02/07/201 01/07/202 PUNE MANET,PUNE

Medical First Aid 5 6 1

/ Medicare

Personal Safety & MANET/PSSR/31/2016/0 29/06/201 PUNE MANET,PUNE

Social 05 6 28/06/202

Responsibility 1

(PSSR)

Security Training STS0631700005 20/06/201 KOLKATA MERCANTILE

for Seafarers 7 MARINE ACADEMY

with Designated

Security Duties

HOBBBIES AND INTRESTS-

8. OTHER CERTIFICATES

Sr.No. Details of the Certificates

1 CERTIFICATE OF PARTICIPATION ON TRAINING PROGRAM ON SOFT SKILLS

2 REGIONAL LEVEL BASKETBALL MEET CERTIFICATE

3 PRE-SENIOR UN INFORMATION TEST CERTIFICATE

9. DANGEROUS CARGO ENDORSEMENTS

Grade / Number Date of Place of Date Of

Dangerous Cargo Level Issue Issue Expiry

Endorsements I / II

10. DECLARATION

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 issued to me has ever been Revoked or Suspended.

Date / / Name

Signature

[pic][pic]

[pic] [pic]

MIT GROUP OF INSTITUTIONS PUNE

MAHARASHTRA ACADEMY OF NAVAL EDUCATION

& TRAINING [MANET]

Gat No.140, Loni-Kalbhor, Rajbaug, Pune-Solapur Highway,

Pune-412201.

Photograph

PLAYING BASKETBALL,READING BOOK

.

1.

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