APPLICATION FORM / PERSONAL DATA UPDATE FORM
RANK APPLIED DATE OF APPLICATION
DECK CADET 21/04/2014
INDOS NUMBER DATE OF AVAILABILITY
12NL1835 ANY TIME
1. PERSONAL DETAILS
NAME FADNIS NADER NAZIM
Date of Birth Place of Birth DAPOLI Nationality INDIAN
23/06/1995
Permanent 1085, BANDER MOHALLA, BURONDI, DEEBA APPARTMENT, ROOM NO. 04,KALKAI KOND, DAPOLI-
Present Address
DAPOLI-415***-******
Address
City & Pin Code : DAPOLI / 415720 City & Pin Code : DAPOLI/415712
Telephone : 962-***-**** Telephone : (02358)283191
: ***********@*****.***
E- mail 1
2. NEXT OF KIN
SURAYYA / MOTHER
NAME / RELATION
SAME AS ABOVE
ADDRESS
Tel : 750-***-****
3. PASSPORT DETAILS
NUMBER PLACE OF ISSUE DATE OF ISSUE DATE OF EXPIRY
L30989943 MUMBAI, INDIA 11/03/2014 10/03/2024
PASSPORT
4. CDC DETAILS:
CDC NUMBER PLACE OF ISSUE DATE OF ISSUE DATE OF EXPIRY
MUMBAI
MUM 222282 11/09/2013 10/09/2023
INDIAN
LIBERIAN
OTHERS
5. ACADEMIC QUALIFICATIONS Grade / Degree From (Year) To (Year)
S.S.C. FIRST CLASS 2009 2010
SCHOOL
H.S.C. FIRST CLASS 2011 2012
COLLEGE
TRAINING SHIP RAHAMAN DIPLOMA IN NAUTICAL 2012 2013
PRE- SEA TRAINING
SCIENCE
INSTITUTE
6. STCW AND OTHER CERTIFICATES
Issuing Authority/
STCW Courses Certificate No. Date of Issue Date of Expiry Place of Issue INSTITUTE
PSSR 010**********-**/02/2013 MUMBAI TRAINING SHIP
RAHAMAN
EFA 008**********-**/02/2013 MUMBAI TRAINING SHIP
RAHAMAN
(First Aid)
PST/ PSCRB 007**********-**/02/2013 MUMBAI TRAINING SHIP
RAHAMAN
(Survival)
FPFF 001**********-**/02/2013 MUM BAI TRAINING SHIP
RAHAMAN
(Fire Fighting)
SECURITY TRAINING TSR/TR/000689 05/02/2013 MUMBAI TRAINING SHIP
RAHAMAN
ARPA
GMDSS
GMDSS END
REFRESHER & UPDATING
RANSCO / NARAS
SMS/ NAV CONTROL
W/K CERT. FOR RATINGS
SIMULATOR TRAINING
ENGINE SIMULATOR
BTM
ECDIS
ICE NAVIGATION
BRM/ ERM / VRM
TANKER COURSES
TASCO / TANKER FAM.
CHEMCO/ CHEM FAM.
GASCO/ GAS FAM.
DCE PETROLEUM
DCE CHEMICAL
DCE GAS
LIQUID CARGO SIM
OTHER COURSES
Safety Officers Cert/ ISPS ( SOC)
HAZMAT
SSO
COOKERY COURSE