Deck Cadet Medical

*. PERSONAL DETAILS

Surname :YADAV First Name :SANJAY Middle Name :KUMAR

Nationality :Indian Date of Birth :20/07/1993 Place of Birth :GONDA

Post Applied for : Deck

cadet

Permanent Address : Present Address :

C 2323 rajaji puram C 2323 rajaji puram

Lucknow Lucknow

PIN Code:226017 Nearest Airport:lucknow PIN Code:226017

Tel No / Mobile Tel No / Mobile

No:+919*********/+919********* No:+919*********/+919*********

Email ID: ***************@*****.***

2. PASSPORT DETAILS

Passport No. Date of Place of Issue Date of Exp. ECNR Blank Pages

Issue

L5187394 28-10-2013 36

LUCKNOW 27-10-2023 NA

3. CONTINUOUS DISCHARGE CERTIFICATE /INDOS

Seaman's Number Date of Issue Place of Expiry Date Remark

Book (CDC) Issue

Indian

INDOS 11NL2018

07/09/2011 India

4. FAMILY INFORMATION

Full Name of Next of Kin : sant ram yadav Relationship :father

Address of Next of Kin : C 2323 rajaji puram lucknow(up)- 226017

Tel No. :

Family Data Name Contact Number/e-mail ID

Father Sant ram yadav +919*********

Mother M k yadav

Vinay kumar yadav +918*********

Brother/Sist

er

Other

5. ACADEMIC QUALIFICATION

QUALIFICATION

YEAR OF PASSING PERCENTAGE BOARD/UNIVERSITY

B.Sc. NAUTICAL 2014 Y.C.M.O.U

70%

H.S.C. 2010 75% UP BOARD

S.S.C. 2008 62% UP BOARD

6. DETAILS OF B.Sc (NAUTICAL) COURSE:

PERCENTAGE AVERAGE

SEMESTER

SEMESTER 1 72.50%

70.00%

SEMESTER 2 64.33%

SEMESTER 3 71.50%

SEMESTER 4 70.67%

SEMESTER 5

66.60%

SEMESTER 6 74.40%

7. STCW AND OTHER CERTIFICATES

Number Dt. Of Dt. Of Pl. of Issued by

Details of Courses Issue Expiry Issue

& Certificates

Fire Prevention And CMET/FPFF/538/621 10/07/201 LUCKNOW CMET

Fire Fighting 2 3

Proficiency in CMET/PST/489/5419 06/07/201 LUCKNOW CMET

Survival Craft / 3

Rescue Boat / PST /

PSC RB Up

gradation

Elementary / CMET/EFA/505/5469 26/06/201 LUCKNOW CMET

Medical First Aid / 3

Medicare

Personal Safety & CMET/PSSR/496/569 13/07/201 UNLIMITED LUCKNOW CMET

Social 2 3

Responsibility

(PSSR)

9. DECLARATION

I hereby affirm that all the information provided by me in this application is

true and correct to the best of my knowledge and belief; further, that no

Certificate issued to me has ever been Revoked or Suspended.

Date Name-SANJAY KUMAR YADAV

Signature- [pic]

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[pic] [pic]

MIT GROUP OF INSTITUTIONS PUNE

MAHARASHTRA ACADEMY OF NAVAL EDUCATION

& TRAINING [MANET]

Gat No.140, Loni-Kalbhor, Rajbaug, Pune-Solapur Highway,

Pune-412201.

[pic]

[pic]Photograph

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