College Marine

P HOTO

RANK APPL I E D FOR : GP RAT I NG

* . * ******* **** *** LARS:

Name F irst Name Middle Name Last name

CHIRANJIT MONDAL

Date of Birth Place of Birth Sex Nationali INDOS No

ty

**/**/1991 DHAWAPARA MAL INDIAN 14GL3636

E

Contact Address Permanent address

PHONE - +(91-760******* VILL+P O- DHAWAPARA, DIST-

EMAIL– N ADIA

******************@*****.*** STATE –WEST BENGAL,PIN

-741155

Height (cms) Weight (Kgs) Color of Eye Color of Hair

171 70 BLACK BLACK

2. NEXT OF K I N :

Name First Name Middle Name Last Name

BISWAJIT MONDAL

Contact address Relation

PHONE - +(91-964******* FATHER AND SON

3. D ETA I LS OF PASSPORT:

Issuing

Number Place of Date of Issue Date of

Count ry

I ssue E xpiry

L9214758 KOLKATA 02/05/2014 01/05/2024 INDIA

4. D ETA I LS OF SEAMAN’S BOOK:

Issuing

Number Place of Date of Issue Date of

Count ry

I ssue E xpiry

KOL 103312 KOLKATA 23/12/2014 22/12/2024 INDIA

5. D ETA I LS OF V ISA:

Type Number Place of Date of Issue Date of

I ssue E xpiry

6. Y.F VACCI NAT IO N:

TYPE DATE OF DATE OF PLACE OF

I SSUE E XPIRY I SSUE

International

certificate of

KOLKATA

vaccination

(YELLOW FEVER )

7. S TCW’95 COURSES:

Yea Cours Institu te/University/Issu Certificate Date of Place of

r e ing No Issue I ssue

Authority

EFA TRIDENT COLLEGE TCMTEFA1436 10/07/2014 KOLKATA

OF 75

M ARINE

T ECHNOLOGY

PST TRIDENT COLLEGE TCMTPST1437 08/08/2014 KOLKATA

OF 21

MARINE

T ECHNOLOGY

FPFF TRIDENT COLLEGE FPFF06414212 23/07/2014 KOLKATA

OF 88

MARINE

T ECHNOLOGY

PSSR TRIDENT COLLEGE TCMTPSSR143 03/11/2014 KOLKATA

OF 724

MARINE

T ECHNOLOGY

STSD TRIDENT COLLEGE TCMTSTS1406 09/10/2014 KOLKATA

SD OF 88

MARINE

T ECHNOLOGY

OTF TRIDENT COLLEGE TCMTOTF1428 29/08/2014 KOLKATA

OF 21

MARINE

T ECHNOLOGY

9. M AR I T I M E COURSE D ETA I LS:

Percentage

Course Academy Certificate Date of Year of

of

Program No. passing pass

Marks

Obtain

TRIDENT “A” G1412K0501 Dec 2014 2014

GP COLLEGE 7/

RATING OFMARIN Dec14/43633

E

T ECHNOL

OGY

10. O T H ER QUAL I F ICAT ION:

Course Subject Studied

11. Well performance in Quiz, GK, Debate and other curricular activities.

I hereby declare that the above furnished details are t rue and correct to

best of my knowledge and belief.

Date:

Place:

Signature

Contact this candidate