High School Medical

*

INTERNATIONAL MARITIME INSTITUTE

**, ********* ****-*,******** Kasna Road,

Greater Noida- 201310

Ph no-012*-*******/2326312/2326313

1.PERSONAL DETAILS

Surname: KATARIA First Name: UJJWAL Middle Name:

Nationality: INDIAN Date of Birth: 18-11-1989 Place of Birth: SINGRAULI (MP) Weight (kg): 65 Height (cm): 175

Post Applied for: TME

Permanent Address: Present Address:

#2671, PHASE-7, MOHALI, IMI COLLEGE, KNOWLEDGE PARK 1, STATE- PUNJAB. SURAJPUR KASNA ROAD, GREATER NOIDA. PIN Code: 160055

Nearest Airport:

CHANDIGARH

PIN Code: 160062

Tel No / Mobile No: +919*********

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

2. PASSPORT DETAILS

Passport No.

Date of

Issue

Place of Issue Date of Exp. ECNR Blank Pages

J7384755 05/07/2011 CHANDIGARH 04/07/2021 36

3. CONTINUOUS DISCHARGE CERTIFICATE / INDOS

Seaman’s Book

(CDC)

Number Date of Issue Place of Issue Expiry Date

Indian MUM 253414 13/10/2015 MUMBAI 12/10/2025

INDOS 14EL2925 MUMBAI

2

4. FAMILY INFORMATION

Full Name of Next of Kin: RANBIR KATARIA Relationship: FATHER Address of Next of Kin: Hno 2671 phase 7 Mohali, Punjab Tel No.+91-981*******

Family Data Name Contact Number/e-mail ID

Father RANBIR KATARIA +91-981*******

Mother URMILA KATARIA +91-998*******

Brother/Sister DINSHAW KATARIA

5. ACADEMIC QUALIFICATION

QUALIFICATION

YEAR OF

PASSING

PERCENTAGE

BOARD/UNIVERSITY

GRADUATE MARINE

ENGINEERING.

2015 55.6%

I.M.U

B.TECH MACHENICAL 2012 56.8%

P.T.U

H.S.C. 2008 62.6% BOARD OF HIGH SCHOOL

AND INTERMEDIATE

EXAMINATION U.P

S.S.C. 2006 50% CBSE

6. DETAILS OF B.TECH COURSE:

SEMESTER

PERCENTAGE AVERAGE %

SEMESTER 1 344 56.8%

SEMESTER 2 431

SEMESTER 3 401

SEMESTER 4 453

SEMESTER 5 470

SEMESTER 6 486

SEMESTER 7 545

SEMESTER 8 819

3

7. STCW AND OTHER COURSES

Details of Courses & Certificates

Number Dt. Of Issue

Dt. Of

Expiry

Pl. of Issue

Advanced / Basic Fire Fighting FPFF-5689 25.06.20 15 Gr.NOIDA Proficiency in Survival Craft / Rescue

Boat / PST / PSC RB Up gradation

PST-4349 25.06.2015

Gr.NOIDA

Elementary / Medical First Aid /

Medicare

EFA-4304 25.06.2015

Gr.NOIDA

Personal Safety & Social

Responsibility (PSSR)

PSSR-4330 25.06.2015

Gr.NOIDA

Petroleum Tanker Familiarization ST-0912 17.07.2015 Gr.NOIDA 10. 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is true and correct to the best of my knowledge and belief; further, that no Certificate issued to me has ever been Revoked or Suspended.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 Signature

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