Service Training

Personal Data

Rank Applied *rd officer Date Available to Any time

For Start

Last Name KHALPE First Name(s) MUDASSAR

Date of Birth 09/11/1980 Place of Birth BRUMBARD

(Not less

than 18

years)

INDOS No. 01GL2543 Nationality INDIAN

Permanent Address

Street Address; SHEE GANESH CO-OP HSG CitySANPADA, NAVI MUMBAI

SOCIETY,B-403, SECTOR-14,

PLOT-18A&18B,

Province/State MAHARASHTRA CountryINDIA Postal Code ; 400705

Secondary Address Mailing Address

Current Address

Street Address; SHREE GANESH CO-OP HSG City; SANPADA, NAVI MUMBAI

SOCIETY, B-403, SECTOR-14,

PLOT-18A&18B;

Province/State; CountryINDIA Postal Code ; 400705

MAHARASHTRA

Primary Phone 932*******( M) / Alternate Phone 022-********

No. 897-***-****(M) No.

Email **************@*****.** MUI Membership

Validity Date

Height 179Cm Weight 73Kg

Travel Documents & Vaccinations

Documents Number Date of Place of Expiry Date Office Use

Issue Issue

DD-MMM-YYYY DD-MMM-YYYY

Orginals

Verified

Passport Z2231187 30-06-2011 THANE 29-06-2021

CDC (National) MUM-118**-**-**-**** MUMBAI TEN YEARS

7

US Visa C1/D

Certificate of COC006204 19-06-2013 UNITED 04-06-2018

Competency Grade...OOW 7 KINGDOM

DECK

Yellow Fever LOT.NO. 07-09-2013 MUMBAI(MMD) TEN YEARS

J5256

Emergency Contacts

Name of Next of Kin- RAMIZA. MUDASSAR. Relationship- WIFE

KHALPE

Contact Information for Next of Kin Phone No. 089********

Street Address- SHREE GANESH CO-OP HSG City- SANPADA( NAVI MUMBAI)

society, B-403, SECTOR-14, PLOT-

18A&18B,

Pre Sea Training / Apprenticeship

NUSI MARITIME / College From To GP RATINGS Marks

27-09-2002 13-02-2003

Previous Sea Service (Data Commencing from Last ATTACHMENT 1

Vessel)

Applicant's Rank : 3RD OFFICER Date :

name:

MUDASSAR.

INAYAT.

KHALPE

Contact this candidate