Application Form / Personnel Data Update Form
Post applied for :CHIEF OFFICER
Willing to accept lower rank? Yes / No
Available From : 01/11/2018
PERSONAL PARTICULARS (AS IN PASSPORT)
First Name : MANAS
Middle Name : KUMAR
Last Name/ Surname : BAG
Nationality :INDIAN
Date of Birth : 23.11.1963
Place of Birth :KOLKATA
Height
(In CMS) 160
Weight (In KGS) 78
Smoker / Nonsmoker
Yellow Fever
Batch / Lot No
Blood Group : A+VE
Veg. / Non. Veg.
DOI
DOE
Boiler Suit Size : MED/LARGE/XL/XXL
Shoe Size : 7
02/09/2011
12/09/2021
011
Permanent Address : “SEVA ENCLAVE’
Local Address :
1032 MADURDAHA, P.S.-ANANDAPUR
City : KOLKATA Tel : +917*********/943-***-****
City : Tel :
Post Code : 700107 Mobile : 700-***-****
Post code : Mobile :
E-mail : ac8gbq@r.postjobfree.com
Document
No.
Date of Issue
(DD/MM/YY)
Place of Issue
Date of Expiry
(DD/MM/YY)
Passport : Country: INDIAN
L4604947
05/09/2013
KOLKATA
04/09/2023
Seaman’s Book (CDC) : National
BY72715
12/06/1996
MUMBAI
01/01/2028
Seaman’s Book (CDC) : Nowegian
Seaman’s Book (CDC) : Liberian
Seaman’s Book (CDC) : Panamian
Seaman’s Book (CDC) : M/Island
Other (CDC) :
Valid US Visa “C1/D” Yes / No
Date of Expiry : 04/01/2021
Passport ECNR : Yes / No
Next of Kin : Mrs. RUMA BAG
Relationship : SPOUSE
DOB : 24.07.1976
Alternate Next of Kin : MS. SUROSREE BAG
(In case of family joining)
Relationship : DAUGHTER
Address : SAME AS ABOVE
Tel :
Family Data
Relationship
First Name
Last Name
DOB
Passport No
Place Issued
Valid Untill
Spouse
RUMA
BAG
24.07.1976
Z4316915
KOLKATA
28/07/2027
Child M/F
SUROSREE
BAG
21/06/2003
N6185414
KOLKATA
21/012021
Indicate Type of Valid Visa
EDUCATIONAL QUALIFICATION
10+2 / Degree
Institution / University
Year of Passing
Class
10+2
WBHSE
1983
1ST
PRE – SEA TRAINING / APPRENTICESHIP
Pre – Sea Training
Training Institution / Company Name
From – To
Class
CERTIFICATES / COURSES :
Highest Competency Certificate Held
Date of Passing Examination
Issuing Authority
Grade
Certificate No
DOI
Place Issued
Valid Until
National (Country) INDIA
MASTER(FG)
IF00-12271
01/07/2014
MUMBAI
30/12/2021
Liberian
Panamian
Marshall Island
Norwegian
Hongkong
Others
GMDSS
OPERATOR
GOC-1132
25/10/1998
NEW DELHI
24/10/2038
LIST OF S.T.C.W. / OTHER COURSES DONE
Courses
Cert No
Data of Issue
Place of Issue
1. FPFF / Advanced Fire Fighting
02697
13/07/2016
KOLKATA
2. Proficiency in Survival Craft & RB / PST
BPMA/PSCRB-RF/7908/2016
05/08/2016
MUMBAI
3. Medical Care (refresher)
28/12/2018
KOLKATA
4. PSSR
SMC/PSSR/185
24/12/1998
KOLKATA
5. CHEMCO(UK)
6. TASCO
7. TASCO(UK)
8. LCHS : (Management / Operation )
9. GMDSS COC
GOC-1132
25/10/2018
10. Ship Maneuvering Simulator Course
TCMTSMS134502
13/09/2013
KOLKATA
11. Radar Observer Course / ARPA
L/134/05
05/04/2007
KOLKATA
12. Radar Simulator Course / RANSCO
SMC/RANSCO/1007
09/03/2011
KOLKATA
13. BTM / BRM
TCMTSMS134502
13/09/2013
KOLKATA
14. ISPS (SSO) Course
02422
28/08/2013
KOLKATA
15. NIS Familiarization Course
-
-
-
16. C.O.C. Revalidation Course
02568
02/09/2016
KOLKATA
17. INDOS No
07NL0599
23/05/2007
MUMBAI
18. Others (Specify)
-
-
-
Dangerous Cargo Certification :
1. Endorsement on NATIONAL Certificate
LEVEL
Number
DOI
Place Issued
Valid Until
OIL
CHEMICAL
2. Endorsement /Cert Obtained (Liberian,etc.)
qualifying as (Capacity)
Level
Number/Issuing Authority
DOI
Place Issued
Valid Untill
SEA SERVICE: ( Start From Last Vessel Served )
Name of the Company
Name of the Vessel
Flag of Vessel
Type of Vessel
Engine Type / BHP
DWT (D)
Rank
From
DD/MM/YY
To
DD/MM/YY
Total
M/D
GRT (G)
ASP SHIP MANAGEMENT PVT LTD
MV MARATHA PRIDE
MARSHALL ISLANDS
BULK CARRIER
7470
22863
CHIEF OFFICER
29/12/2017
30/07/2018
07/01
ASP SHIP MANAGEMENT PVT LTD
MV MARATHA PARAMOUNT
MARSHALL ISLANDS
BULK CARRIER
9168
19785
CHIEF OFFICER
25/11/2016
11/07/2017
07/16
ASP SHIP MANAGEMENT PVT LTD
MV MARATHA PRIDE
MARSHALL ISLANDS
BULK CARRIER
7470
22863
CHIEF OFFICER
04/02/2016
08/07/2016
05/04
ASP SHIP MANAGEMENT PVT LTD
MV MARATHA PRIDE
MARSHALL ISLANDS
BULK CARRIER
3089
4526
CHIEF OFFICER
23/05/2015
02/10/2015
04/09
MERCATOR SHIPPING
MV KESARI PREM
PANAMA
BULK CARRIER
11199
36698
CHIEF OFFICER
23/01/2015
16/08/2015
06/23
MERCATOR SHIPPING
MV KANAK PREM
PANAMA
BULK CARRIER
11199
36698
CHIEF OFFICER
26/05/2014
14/10/2014
04/18
MERCATOR SHIPPING
MV GAURAV PREM
PANAMA
BULK CARRIER
13673
40230
CHIEF OFFICER
10/11/2012
07/04/2013
04/27
APJ SHIPPING
APJ SURYAVIR
INDIAN
BULK CARRIER
10200
38302
CHIEF OFFICER
17/07/2012
07/10/2012
02/20
GESCO
MV JAG ARNAV
INDIAN
BULK CARRIER
38265
CHIEF OFFICER
06/09/2011
03/03/2012
05/27
PRATIBHA SHIPPING
MT PRATIBHA NEERA
INDIAN
PRODUCT
11900
18625
2ND OFFICER
08/03/2010
05/07/2010
3/27
GESCO
MT JAG PARWAR
INDIAN
PRODUCT
8150
19925
2ND OFFICER
16/10/2009
23/01/2010
03/07
GESCO
MT JAG PAVITRA
INDIAN
PRODUCT
12250
28010
2ND OFFICER
17/02/2009
20/08/2009
06/03
Remarks:
DECK OFFICERS :
1.CARGOES CARRIED: …GRAIN, LOG, STEEL, FERTILIZER
2.TRADING PATTERN : …WORLD WIDE
ENGINEERS / ELECTRICAL OFFICERS / DECK OFFICERS :
1.EXPERIENCE ON DECK / CARGO MACHINERY : YES
2.EXPERIENCE ON GRABS : YES
3.EXPERIENCE ON PUMPS ON TANKERS (FOR DECK OFFICERS & ENGINEERS ) :…YES
4.EXPERIENCE ON COMPUTERISED PMS (AMOS / TM-MASTER) YES
GENERAL :
(A) Have you ever been denied a foreign visa Yes / No
If yes, state which country and reason (if known) :
(B) Have you been the subject of a court of enquiry or involved in a maritime accident? Yes / No
If yes please attach details.
(C ) Have you ever signed off a ship due to medical reason? Yes / No
If yes, please provide following details :
Name of the vessel
Date of Occurrence
Place of Occurrence
N/A
N/A
N/A
Reason for sign off : N/A
(E)References
Please give referees from two recent employers who we may contact for references
Reference 1
Reference 2
Name of Company
ASP SHIPPING (IND) PVT LTD
Name of person to contact
CAPT. FIROZ KOTWAL
Address
ATRIUM 215 ‘A’ WING, ANDHERI EAST, MUMBAI-400093
Country
INDIA
Telephone
I Do Hereby Declare That All Information Furnished Is True To Best of My Knowledge And Belief.
Received acknowledgement of Application form.
Date: 11-02-2019 Rank: CHIEF OFFICER Candidate Signature: