RANK APPLIED
Trainee Marine Engineer
INDOS NUMBER
17EL1875
1. PERSONAL DETAILS SURNAME FIRST NAME MIDDLE NAME
NAME
SURIN
AJAY
KUMAR
Date of Birth
Place of Birth
KAPURTHALA
Nationality
INDIAN
Permanent Address
RAJABASA
GUTBAHAR, SIMDEGA
PIN: 835223, JHARKHAND, INDIA
Present Address
438-B TYPE-2
RAIL COACH FACTORY, KAPURTHALA PIN:144602, PUNJAB,INDIA
City & Pin Code : SIMDEGA - 835223
City & Pin Code : KAPURTHALA - 144602
Mobile No. : 946-***-****
E- mail : ***********@*****.***
2. NEXT OF KIN / FAMILY PARTICULARS
NAME / RELATION
MANJULA HORO / MOTHER
ADDRESS
RAJABASA
GUTBAHAR, SIMDEGA
PIN: 835223, JHARKHAND, INDIA
3. PASSPORT DETAILS
NUMBER
PLACE OF ISSUE
DATE OF ISSUE
DATE OF EXPIRY
PASSPORT
P9972423
RANCHI
30/06/2017
29/06/2027
4. CONTINUOUS DISCHARGE CERTIFICATES
CDC
NUMBER
PLACE OF ISSUE
DATE OF ISSUE
DATE OF EXPIRY
INDIAN
KOL107399
KOLKATA
21/05/2018
20/05/2028
5. ACADEMIC QUALIFICATIONS Grade / Degree From(Year) To (Year)
SCHOOL
KV RCF
SSLC - 65%
2007
2008
SCHOOL
PRIVATE CANDIDATE
HSC - 56%
2010
2011
COLLEGE
SLIET
DIPLOMA- 71%
2011
2013
COLLEGE
ACEM
B.E -MECH – 72%
2013
2016
PRE- SEA TRAINING
INSTITUTE
COCHIN SHIPYARD LTD (METI)
GME – 62%
2017
2018
6. STCW AND OTHER CERTIFICATES
STCW Courses
Certificate No.
Date of Issue
Date of Expiry
Place of Issue
Issuing Authority/ INSTITUTE
PSSR
PSSR/EMA/1183-18/020095
18/01/2018
UNLIMITED
KOCHI
EURO TECH MARITIME ACADEMY
EFA
EFA/1485/2018
17/02/2018
UNLIMITED
KOCHI
COCHIN SHIPYARD LIMITED
PST(Survival)
PST/EMA/1178-18/019318
07/03/2018
UNLIMITED
KOCHI
EURO TECH MARITIME ACADEMY
FP & FF
(First Fighting)
FPFF/5823/2018
19/01/2018
UNLIMITED
KOCHI
COCHIN SHIPYARD LIMITED
STSDSD
METI/STS/2559
24/01/2018
UNLIMITED
KOCHI
COCHIN SHIPYARD LIMITED
SIMULATOR TRAINING
ENGINE SIMULATOR
SOL/143/1520
28/02/2018
UNLIMITED
KOCHI
KUNJALI MARAKKAR SCHOOL OF MARINE ENGINEERING
TANKER COURSES
GAS TANKER FAMILIARISATION
30/11/2018
UNLIMITED
MUMBAI
MARITIME TRAINING INSTITUTE
(SCI)
TANKER (OIL, CHEMICAL COMBINED)
07/12/2018
UNLIMITED
MUMBAI
MARITIME TRAINING INSTITUTE (SCI)
OTHER COURSES
AUGFF
TFFC/171/2018
25/01/2018
UNLIMITED
KOCHI
COCHIN SHIPYARD LIMITED
7. DECLARATION
I declare that the information given above is complete and true to the best of my knowledge. I also declare that the documents submitted are genuine, given and signed by the persons whose names appear on them. Any false declaration may render me liable for termination or dismissal
Date: SIGNATURE OF APPLICANT: