contct no.:91-904*******

APPLICATION FORM

POST APPLIED FOR

able seamen

Personal Information

Name

AKSHAY PANDEY

Date & Place Of Birth

**/**/**** ****** (U.P)

Permanent Address

***/*** *.ROAD, GANDHI NAGAR, RAM PARK, KANPUR

Contact No.

089********, 098********

Next Of Kin / Relation

KALPANA PANDEY (MOTHER)

Next Of Kin Address

106/121 P.ROAD, GANDHI NAGAR, RAM PARK,KANPUR

Next Of Kin Cont. No.

080********

Qualification

B.A( GRADUATE)

Tech. Qualification

Travel Documents

Document Name

Certificate No.

At

Place Of Issue

On

Issue

Till

Expiry

Passport No.

L2754172

At

LUCKNOW

On

14/06/2013

Till

13/06/2023

CDC (Indian) No.

MUM 228412

At

MUMBAI

On

30/01/2014

Till

29/01/2024

CDC (Panamian) No.

At

On

Till

CDC (Marshall) No.

At

On

Till

CDC (Other) No.

At

On

Till

COC (Indian) No.

At

On

Till

COC (Panamian) No.

At

On

Till

COC (Other) No.

At

On

Till

US Visa

At

On

Till

GMDSS

At

On

Till

Yellow Fever

At

DELHI

On

29/3/2014

Till

29/3/2024

STCW & Other Certificate

Sr. No.

Courses

Certificate No.

Issue

Expiry

Place Of Issue

1

P.S.S.R

YAK/PSSR/737

08/05/2013

UNLIMITED

NAVI MUMBAI

2

P.S.T

YAK/PST/757

22/05/2013

UNLIMITED

NAVI MUMBAI

3

M.F.A /E.F.A

YAK/EFA/746

11/05/2013

UNLIMITED

NAVI MUMBAI

4

A.F.F./FPFF

YAK/FPFF/7351

25/05/2013

UNLIMITED

NAVI MUMBAI

5

P.S.C.R.B

6

S.S.O

7

P.S.C

YAK/G.P/1704

30/06/2013

UNLIMITED

NAVI MUMBAI

8

O.T.F.C

YAK/OTFC/696

03/05/2013

UNLIMITED

NAVI MUMBAI

9

DCE (O.T.F.C)

D/0/1/D/14/19763

02/04/2014

NOIDA

10

C.T.F.C

CT-14069

28/03/2014

UNLIMITED

NEW DELHI

11

DCE (C.T.F.C)

D/C/1/D/14/19764

02/04/2014

NOIDA

12

G.T.F.C

13

DCE (G.T.F.C)

14

P.S.C.R.B

15

A.F.F

16

I.S.P.S.

17

I.S.M. CODE

18

A.R.P.A

19

R.O.C

12

Watch Keeping No.

CMMI/WK/NAV/15/1727

13

Indos No.

13GL1552

INDIA

Sea Experience

Sr

Company Name

Vessel Name

Type

SEA TIME

GRT

Rank

From

To

S.K ENGINEERING

MT BETELGEUSE

OIL TANKER

3

MONTHS

28932

O.S

10 JULY 2014

09 OCT 2014

S.K ENGINEERING

MT BRIGHT (VLCC)

OIL TANKER

6 MONTHS 3DAYS

156096

O.S

19 DEC 2014

21 JUNE 2015

Bank Details For Salary

Sr. No.

Name

Details

1.

LAST Salary

1230 USD

2.

Bank

3.

A/C

4.

Bank Address.

5.

Code Of The Bank

Declaration: I hereby declare that the details furnished above are true to the best of my knowledge & belief.

DATE 22 SEPT 2015

SIGNATURE:-

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