APPLICATION FORM

POST APPLIED FOR E NG

*ND

PERSONEL INFORMATION

KAMAL SINGH

Name

30.04.1981 / SUTANA

Date /Place of birth

HNO-279-VPO-SUTANA, TEH - MALAUDA, DISTT-PANIPAT- 132105

Permanent Address

098********/ 981-***-****

Contact No.

KALI RAM / FATHER

Next to kin /Relation

HNO-279-VPO-SUTANA, TEH - MALAUDA, DISTT-PANIPAT- 132105

Next to kin Add./ Contact No.

10 + 2

Qualification

Tech. Qualification

TRAVEL DOCUMENTS

26.06.22

PASSPORT No. K2795382 at CHANDIGARH on 27.06.12 till

23.06.23

CDC (INDIAN) No. MUM 217731 at INDIA on 24.06.13 till

CDC (BAHAMAS) No. 39439 at BAHAMAS on 29.04.04 till

CDC (GEORGIA) 039104 at on 22.07.10 till

24.06.2016

COC (BELIZE) No. 4175 at INDIA on 25.06.11 till

COC (LIBERIAN) no. at on till

COC (PANAMIAN) No. at on till

GMDSS at on till

WATCH KEEPING No at on till

INDOS No. 09HL7130 at on till

STCW'95 & OTHER CERTIFICATES

Place of Issue

Sr. Course Certificate No. Issue Date Expiry

P.S.S.R MUMBAI

1 463/01/2004 06.02.2004

MUMBAI

2 P.S.T 466/03/2004 06.02.2004

MUMBAI

3 E.F.A 489/07/2004 06.02.2004

MUMBAI

4 F.P.F.F 339/01/2004 31.01.2004

P.S.C& R.B MUMBAI

5 PSCRB/0415/020/09 19.02.09

MUMBA1

A.F.F AFF/022/049/09 13.02.09

7 O.T.F.C. 4678/09 MUMBAI

8 D.C.E. (O.T.F.C.) APPLIED ---

9 O.E.W. GMTI-OEW-0019 01.06-10 --- KARACHI

10 F.A.B.C. GMTI-FABC-0019 01.06.10 -- KARACHI

11 B.F.F. GMTI-BFF-0019 01.06.10 -- KARACHI

12 P.S.S.R. GMTI-PSSR-0019 01.06.10 --- KARACHI

13 P.S.T. GMIT-PST-0019 01.06.10 -- KARACHI

14 M.F.A. MFA/011/711/09 04.02.09 -- KARACHI

15 P.S.C.R.B. GMTI-PFRB-0019 01.06.10 -- KARACHI

16 YELLOW FEVER --

17 ENDORSEMENT E/M120309154007/M 09.03.12 -- MONACO

18 ENDOSMENT 397*-**-**-** -- BAHRAIN

19 WELDING SAFETY 243**-**-**-** -- ABU

DHABI

21 SAFE LIFTING 243**-**-**-** -- ABU

OPERATION DHABI

22 BREATHING APPARATUS 586**-**-**-** -- ABU

H2S DHABI

23 BASIC OFFSHOPE 005857002407125430 24-07-12 -- ABU

SAFETY INDUCTION DHABI

EMERGENCY TRAINING

(OPITO)

SEA SAILING EXPERIENCES

SR COMPANY VESSEL TYPE GRT BHP RANK FROM TO

NAME NAME

1 BLUE SEA MT.SAKIR TANKAR 3500 2200 OILER 06.05.04 24.02.05

OCEAN

2 MARCO SHIPP R.P. MERDIF-2 RORO 17691 2X9400 OILER **-**-**-**-**-**

AGENCY (L.L.C.)

3 ARIES SHIPPING IVY QUEEN TANKAR 1124 800 3RD **-**-**-**-**-**

ENG

4 BARIA SHIPPING LADY O.S.V. 950 750X2 2ND 21.01.09 03.12.09

CHARYA ENG

5 YMG SHIPPING RESCO -2 T.TUG 310 815 2ND 07.02.10 22.08.10

ENG

6 ZAKHER ZAKHER AHTS 1973 5150 2ND 05.07.11 24.10.11

MARINE COMMANDER ENG

INTERNATIONAL

7 ZMI ZAKHER AHTS 1973 2x 2ND 24.12.11 07.04.2012

EMPEROR CAT ENG

3516 b

8 ZMI ZAKHER AHTS 1092 5150 2ND 13.07.12 24.11.12

FORCE ENG

9 ZMI ZAKHER AHTS 828 4000 2ND 08.02.13 16.05.13

FALCON ENG

10 ZMI ZAKHER AHTS 1092 5150 2ND 06.07.13 04.08.13

FORCE ENG

11 ZMI ZAKHER AHTS 1092 5150 2ND 23.08.13 21.10.13

FORCE ENG.

12 ZMI ZAKHER AHTS 1092 5150 2ND 15.12.13 15.03.14

FORCE ENG.

SIGNATURE Date: 28/03/2014

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