**-***-****

Seafarer Profile

Last updated date : 05/05/2019 06:34 PM Date :

: Nautical

Personal Details

Name

Gender

Date of Birth

Place of Birth Birth State

Birth Country Nationality

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MOHAMED THARIQ AZEEM AJMUL KHAN

MALE

28/04/1998

RAMANATHAPURAM TAMILNADU

INDIA INDIAN

16HL4815

SOUTH STREET

:

City

State

City

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Pin

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Pin

Address

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Address : :

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Address Details

Present Address Permanent Address

KAKKOOR POST

MUTHUKULATHUR

RAMANATHAPURAM

: 623711

TAMILNADU State :

KAKKOOR POST

MUDUKULATHUR

MUDUKULATHUR TK,

623711

Tamil Nadu

SOUTH STREET

Country :

Telephone No. :

Country :

Telephone No. :

Mobile No. :

Email Id :

INDIA

741-***-****

860-***-****

ac9kho@r.postjobfree.com

INDIA

773-***-****

Physical Details

Hair Color

Eye Color :

Height (in Cms) :

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Identification : RIGHT SIDE OF THE FOREHEAD

183

BLACK

BLACK

MEDIUM

INDoS No.

Discipline

:

Report generated on : 05/05/2019 6.35 PM Page 1 of 3 Education Details

Name of Institution

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Main Subjects :

Year of Passing :

English Mark :

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Institute Address :

English, Maths, Science

332****-****

75.6

NABEESAAMMAL

STATE BOARD

RAMANATHAPURAM

2 . 10TH (Matriculation/SSC)

Certificate No.

Education Level :

Name of University

PCM Mark Result /Grade

Name of Institution

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:

:

:

Main Subjects :

Year of Passing :

English Mark :

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Institute Address :

PHYSICS,COMPUTER,MATHEMATICS

100***-****

51.16 69.5

54

NABEESAAMMAL

STATE BOARD

RAMANATHAPURAM

1 . 10+2 (HSC/Intermediate/equivalent)

Certificate No.

Education Level :

Name of University

PCM Mark Result /Grade

Name of Institution

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Main Subjects :

Year of Passing :

English Mark :

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Institute Address :

CHARTWORK, METROLOGY, BRIDGE EQUIPMENTS, NAVIGATION, SHIPSTA CC/CT/363-16 2017

pass

JAMS

BARATHIYAAR

Thisayanvillai

3 . Diploma

Certificate No.

Education Level :

Name of University

PCM Mark Result /Grade

Total no of record in Education Details : 3

Authorised Documents

1 . Document Type : INDoS

Document Type : INDoS

Document Number :

Valid Upto :

Issued Date :

Issued At :

16HL4815 15/09/2016

INDIA

2 . Document Type : Passport

Document Type : Passport

Document Number :

Valid Upto :

Issued Date :

Issued At :

P5468933 23/11/2016

22/11/2026 MADURAI

Report generated on : 05/05/2019 6.35 PM Page 2 of 3 Authorised Documents

3 . Document Type : CDC

Document Type : CDC

Document Number :

Valid Upto :

Issued Date :

Issued At :

MUM 346113 08/12/2018

07/12/2028 MUMBAI

Total no of record in Authorised Documents : 3

I hereby declare that the particulars entered in the form are correct and true to the best of my knowledge and belief and that the papers enumerated in this form are true and genuine documents given and signed by the person whose names appears on them. I further declare that Seagoing service information entered is a true and correct account of my sea-going service without exception and I make this declaration conscientiously believing the same to be true. The documents in original will be presented to the examiner at the time of taking oral examination or at an earlier time when asked by the department. DECLARATION TO BE MADE BY CANDIDATE :

Date :

Signature of the candidate

This is an electronically generated document hence it does not require any signature of DGS Officials. Report generated on : 05/05/2019 6.35 PM Page 3 of 3

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