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Personal Data(name should be strictly as per passport )
BABU
First Name MOHANDEEP Middle Name Surname
CHENNAI 25-Nov-86
Nationality INDIAN Place of Birth Date of Birth
Yes
3RD OFFICER ANY DAY
Post Applied For Accept to sail in lower rank? Available From:
No. NO
Permanent address Local address
NO:34, FIRST STREET
NO:34, FIRST STREET,
AFFIX RECENT
SASTRI NAGAR,
SASTRI NAGAR, PASSPORT SIZE
PHOTO HERE
VYASARPADI
VYASARPADI
Postal code: City CHENNAI Postal code: City CHENNAI
State TAMILNADU Country INDIA State TAMILNADU Country INDIA
Contact Details Code 44 Tel.no. 25520278 Contact Details Code 44 Tel.no. 25520278
Mob no. 996-***-**** Mob no. 984******* Mob no. 996-***-**** Mob no. 974*******
Email ************@*****.*** Nearest Airport chennai
Travel Documents
Place of Issue
Passport No. Date of Issue Date of Expiry ECNR(Y/N/NA) Min. 4 blank pages(Y/N)
F4319905 7/29/2005 7/28/2015 CHENNAI YES YES
Place of Issue UID Number PAN Number
US Visa No.(C1D) Date of Issue Date of Expiry
F4723450 7-Jan-13 3-Jan-18 CHENNAI
CDC Details CDC No. Date of Issue Date of Expiry Issued by(Country) Place of issue
CH55658 8/24/2008 8/23/2018 INDIA CHENNAI
License/Wkeeping License No. Date of Issue Date of Expiry Issued by(Country) Place of issue
2mate FG IF-25936 11/11/2011 10/12/2016 INDIA MUMBAI
GMDSS License No. Date of Issue Date of Expiry Issued by(Country) Place of issue
GOC-C-2485 8/13/2010 8/12/2020 INDIA CHENNAI
Endorsements
Level (Y/N)
Vessel Type Flag SUP OPS MGT Number Date of issue Date of expiry Place of Issue
DCE(Oil) 11/21/2012 12/31/2016 CHENNAI MMD
YES DCE/OT/DK/CHE/1447/12
DCE(Chemical) 11/21/2012 12/31/2016 CHENNAI MMD
YES DEC/CT/DK/CHE/1448/12
DCE(Gas)
Gmdss(Endorse) OPERATIONAL GMDSS/MMD/CHE/656/11
11/24/2011 8/12/2015 CHENNAI MMD
Family Name Date of birth PPT.No. Date of issue Date of expiry Place of Issue
Wife NO
Child M NO
F
Child M NO
F
Physical details
Height : 166 cms Weight : 69 Kgs Boiler Suit Size ( S, M, L, XL, XXL) : L Shoe Size (9) :
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Eye Color: BLACK Hair Color: BLACK Distinguishing Mark: A MOLE ON THE LEFT HAND
Civil Status:(Please mention "yes" where appropriate) Wedding Anniversary Date (if applicable):
Single YES Married Separated Divorced Widowed
Next Of Kin details
First Name K.G.KUMAR Middle Name Surname
Sex:(M/F) M Relationship UNCLE D.O.B
Postal address:
AL 103, 11TH MAIN ROAD Postal code: 600040 City CHENNAI
SHANTHI COLONY, State TAMILNADU Country INDIA
ANNA NAGAR Contact Details Code 44 Tel.no. 26213679
Mob no. Email:
Academic Qualification(Highest qualification attained to be mentioned)
Name of the Institution Qualification From To Percentage/Grade
ACADEMY OF MARITIME EDUCATION AND TRAINING BSC.NAUTICAL SCIENCE
2005 2008 80.40%
Country INDIA State TAMILNADU City CHENNAI Postal code: 603112
S.S.C (10th) Marks % : 72 H.S.C. (12th ) Marks % : 72 H.S.C. (PCM) %
Pre-Sea course details
Name of the Institution Type of Degree From To
ACADEMY OF MARITIME EDUCATION AND TRAINING
BSC.NAUTICAL SCIENCE
2005 2008
Country INDIA State TAMILNADU City CHENNAI Postal code: 603112
Details of Courses & Certificates Number Date of Issue Date of Expiry Issued by
Basic STCW Courses
Fire Prevention and Fire
FPFF FPFF/5247/2007 1-Sep-07 31-Aug-12 AMET UNIVERSITY
Fighting
Basic Fire Fighting BFF
Advanced Fire Fighting AFF AFF/B273/08 8-May-10 7-May-15 HIMT
Elementary First Aid EFA EFA/5389/2007 25-Aug-07 24-Aug-12 AMET UNIVERSITY
Medical First Aid MFA MFA/B598/06 1-May-10 30-Apr-15 HIMT
Medicare
Personal Survival Techniques PST PST/6395/2007 22-Aug-07 21-Aug-12 AMET UNIVERSITY
PSCR
B
Proficiency in Survival Craft
RB PSCRB/B270/02 14-May-10 13-May-15 HIMT
& Rescue Boat
Bridge Team Banagement BTM 440 18-Nov-11 17-Nov-16 IMC
Personal Survival & Social PSSR PSSR/5751/2007 29-Aug-07 28-Aug-12 AMET UNIVERSITY
Responsibility
Other STCW courses
Bridge resource Management BRM
Automatic Radar Plotting ARPA/B122/01 4-Jun-10 3-Jun-15 HIMT
ARPA
Aid
ECDIS ECDIS/B51/07 24-Apr-14 UNLIMITED HIMT
Ship Handling Simulator SMS
M
Engine Room Simulator ERS
O
Ship Safety Officer SOC
Ship Security Officer SSO SSO/B140/12 20-Dec-11 19-Dec-16 HIMT
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Ship Security Officer SSO SSO/B140/12 20-Dec-11 19-Dec-16 HIMT
Vessel Type courses
Oil Tanker Familiarization OTFC/2280/2008 17-Mar-08 16-Mar-13 AMET UNIVERSITY
OTFC
Vessel Type courses(Continued) Number Date of Issue Date of Expiry Issued by
Specialized training on Oil TAS
TASCO/B163/01 29-Sep-12 28-Sep-17 HIMT
Tanker Operations CO
Chemical Tanker CTF/B141/08 13-Jun-08 12-Jun-13 HIMT
CTFC
Familiarization
Specialized training on Chem CHEM
CHEMCO/B92/03 13-Oct-12 12-Oct-17 HIMT
Tanker Operations CO
Gas Tanker Familiarization GTFC
Specialized training on Gas GAS
Tanker Operations CO
LCHS
Liquid Cargo Handling M
(O) 368 17-Oct-12 16-Oct-17 IMC
Simulator O
FRAMO
Other Courses
Pumpman training
Cookery course
Other Documents
Yellow Fever vaccination YF 28-May-14 27-May-24
INDOS Number 07NL1264
Vessel Type Experience(Please mark "Y" where applicable)
Anchor
OFF SHORE OSV D P Vessel Hndlingv/l
BULK Cape size Handy size Y Panamax Y OBO VLOC
CHEM-OIL TANKER Type I Type II Y Type III
Chemical
CHEMICAL TANKER Y
Tanker
CONTAINER Container
GAS TANKER Fully-Ref LNG Pressurized Semi-Ref VLGC
General
GENERAL CARGO PCC Reefer Ro-Ro
Cargo
OIL TANKER Product Crude LR Series Suez Max VLCC
PASSENGER Cruise Line Ro-Ro STP
OTHER Live Stock heavy lift
Reference
S/N Name of the company Person in charge Designation Phone No
1
2
For Office use only
Medical History
If yes,please give
(a) Have you ever signed off from a ship due to Medical reasons, (Please mark "Y" if applicable) N details
Name of the vessel Date of incident Brief Decription(Injury/Illness/accident)
(b) Did you suffer or Are you Presently suffering from any Disease likely to render you unfit for Service at Sea or N
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N
likely to endanger the health of others on board. (Please mark "Y" if applicable)
(c) Are you addicted to alcohol or drugs of any kind. N
(d) Have you suffered from following(Please mark "Y" if applicable)
Malaria N Diabetes N Epilepsy N Nervous Disability N Did you ever undergo psychiatric treatment :
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ov-86
Y DAY
RECENT
RT SIZE
HERE
278
ges(Y/N)
of Issue
NAI MMD
NAI MMD
NAI MMD
of Issue
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plicable):
679
3112
3112
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give
N
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N
N
N
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Engine
Name of Company Name of Vessel Rank Type GRT KW From
S/N Make Model
PENTAGON M.T ISOLA CELESTE 3/0 OIL-CHEMICAL 30123 MAN B&W 10/25/2013
PENTAGON M.T.BLUE GREEN TIGRE 3/0 CHEMICAL 5083 MAK X9M25 10-Feb-13
ETA M.V.SIAM JADE DK CDT BULK 16582 MITSUBISHI UE 6U3C521A 7-Dec-09
ETA M.V.ANTWERP ACE DK CDT BULK 36974 SULZER 6RND 76M 8-Oct-08
I warrant and represent that:
1. The foregoing details are true and accurate and complete
2. There are no contractual or other restrictions (other than official visa/ work. Permit Approvals) or health conditions that may in any way Prevent or restrict me form being employed by you and fully performi
3. I apply for employment with you by my own free will without any inducement or representative from you or your agents.
4. Future that no Certificate of competency or license issued to me has ever been revoked or suspended.
5. I also certify that my medical history contained above is true and any false statement or undisclosed Material information about past illness or injury will disqualify me from any employment benefits and cla
Date Rank Signature of Seaman
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For Office use only
INITIAL CHECK & VERIFICATION (Please mark "Y" if applicable)
A. Original licenses sighted by STCW and Training Certificates sighted by
Experience confirmed by interview by Other details confirmed by interview by
B. OC 09A-Offer letter Signed / attached Interview Sheet Signed / attached Trade test Certificate for new joiners Sighted
Assessment & Evaluation: Approved Conditionally approved Reject Re-interview by Sign/Name:
C. 1 Data Entry doneby: Date: Zone: Sign:
2 Dox attached by: Date: Zone: Sign:
3 1&2 verified by: Date: Zone: Sign:
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Total Reason for S/OFF
To MM/DD
3/8/2014 04 14 CONTRACT COMPLETED
12-Apr-13 02 12 CONTRACT COMPLETED
8-Mar-10 03 01 CONTRACT COMPLETED
19-Aug-09 10 11 CONTRACT COMPLETED
lly performing my work.
efits and claims.
aman
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Date: