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APPLICATION FORM

POST APPLIED FOR

AB

Personal Information

Name

ABHIJIT TAYADE

Date & Place Of Birth

12.05.1992 /

Permanent Address

KAMGAR NGR BMC CLNY BLDG NO A/4-5 KURLA (E) MUMBAI 400024

Contact No.

(0091)704-***-****

Next Of Kin / Relation

ARUN SONAJI TAYADE(FATHER)

Next Of Kin Address

KAMGAR NGR BMC CLNY BLDG NO A/4-5 KURLA (E) MUMBAI 400024

Next Of Kin Cont. No.

(0091)869-***-****

Qualification

10 + 2

Tech. Qualification

Travel Documents

Document Name

Certificate No.

At

Place Of Issue

On

Issue

Till

Expiry

Passport No.

K7557506

At

MUMBAI

On

12,12,12

Till

11.12.22

CDC (Panamian) No.

CTB 327534

At

MUMBAI

On

18.12.12

Till

18.12.17

Yellow Fever

089

At

MUMBAI

On

04.03.13

Till

03.03.23

STCW & Other Certificate

Sr.

Courses

Certificate No.

Issue

Expiry

Place Of Issue

1

PRE SEA

STET MAR-CST-12-01-1147

26.11.12

MUMBAI

2

P.S.S.R

MMTI/PSSR/11559/2012

12.11.12

MUMBAI

3

P.S.T

MMTI/PST/10683/2012

15.11.12

MUMBAI

4

E.F.A

MMTI/EFA/11318/2012

19.19.12

MUMBAI

5

F.P.F.F.

MMTI/FPFF/11960/2012

06.11.12

MUMBAI

6

O.T.F.C

MMTI/OTF/10182/2013

04.02.13

MUMBAI

7

DCE (O.T.F.C)

518244

04.12.13

MUMBAI

8

C.T.F.C

MMTI/CTF/7691/2013

11.02.13

MUMBAI

11

L.G.T.F

MMTI/GTF/5284/2013

18.02.13

MUMBAI

12

Indos No.

12 HL 9152

21.12.13

MUMBAI

Sea Experience

Sr

Company Name

Vessel Name

Type

BHP

GRT

Rank

From

To

1

ETIHAD SHIPPING

M.T RAKAN 1

TNKR

84*2

1735

DK.CDT

18.12.13

11.11.14

Date: Signature:

ABHIJIT.A.TAYADE

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