APPLICATION
Personal Data
Position Applied for:
Willing to accept Lower Rank Yes
No
Available From (DD/MM/YYYY):
ORDINARY SEAMAN
(As per the Passport)
Surname:
Other Names:
WAHUMPURAGE
MIGARA SAMPATH
Nationality
Date of Birth (DD/MM/YYYY)
Place of Birth
SRI LANKAN
29/07/1989
POLONNARUWA
Marital Status
Gender
Male Female
Religion
SINGLE
BUDDHIST
Height (CM)
Weight (KG)
Blood Group
Overall Size
Safety Shoes Size
164
62
O+
MEDIUM
44
Permanent Address
Present Address
A 132/2, KITHALANGAMUWA, DUNUMALA.
A 131/2, KITHALANGAMUWA, DUNUMALA.
Contact Details
Contact Details
Home No:
Home No:
Mobile No:
Mobile No:
Email:
actqms@r.postjobfree.com
Email:
Full Name of Next of kin
Relationship
Gender
Nationality
WAHUMPURAGE SISIRA KUMARA
FATHER
Male Female
SRILANKAN
Address
Contact Details
A 131/2, KITHALANGAMUWA, DUNUMALA.
Home No: 035-*******
Mobile No: 072-*******
CDC/Passport/Documents/Visa
Type of Document
Country of Issue
Number
Place of Issue
Date of Issue
(DD/MM/YYYY)
Valid Until
(DD/MM/YYYY)
Seaman Book (CDC)
SRI LANKA
C 037884
COLOMBO
16/11/2011
15/11/2016
Passport
SRI LANKA
N 2794410
COLOMBO
14/01/2011
14/01/2021
National ID
SRI LANKA
892112282V
COLOMBO
22/08/2006
Yellow Fever
SRI LANKA
AB 371181
COLOMBO
27/11/2013
27/11/2023
Certificate of Competency & Watch Keeping Certificate
Qualifications
Type/Grade/Class of License/Country of Issue
Number
Date of Issue
Date of Expiry
Certificate of Competency
WATCH KEEPING CERTIFICATE (DECK)
SRI LANKA
019389
02/02/2016
01/02/2021
STCW Courses/ Other Recommended Certificates
Details of Courses & Certificates
Number
Date of Issue
Date of
Expiry
Issued by
Personal Safety & Social Responsibility
LATS/PSSR/11312
13/01/2016
13/01/2021
LANKA ACADAMY
Fire Fighting
LATS/FPFF/16584
06/01/2016
06/01/2021
LANKA ACADAMY
Personal Survival Techniques
LATS/PST/16380
09/01/2016
09/01/2021
LANKA ACADAMY
Medical First Aid
LATS/EFA/17800
02/10/2013
02/10/2018
LANKA ACADAMY
Designated Security Duties
LATS/SDSD/3751
19/01/2016
19/01/2021
LANKA ACADAMY
English Language
MSTI/MESL/282
27/10/2011
MSTI
Deck Raiting Certificate
MSTI/DECK/166
27/10/2011
MSTI
TANKER FAMILIARIZATION
LATS/TFA/4486
20/02/2016
20/02/2021
LANKA ACADAMY
Previous Sea Service (Commencing from Last Vessel) All Fields are Mandatory
Name of Company
Name of Vessel
Flag
Type
GRT
BHP
DWT
Rank
From
(dd/mm/yy)
To
(dd/mm/yy)
Total Sea Service
(dd/mm/yy)
Reason for Sign-Off
NATIONAL BUNKERING CO. LTD.
M.T. FAJR
SAUDI ARABIA
OIL TANKER
2977
2800 KW
4991
OS
12/07/2013
19/10/2015
07/03/01
COMPLETE CONTRACT