APPLICATION FOR POSITION AS: THIRD OFFICER/JUNIOR OFFICER TDPO

Surname: AMBROSE First Name: ANDREWS ASHOK KUMAR

Nationality: INDIAN Date of Birth: 30-11- Age: 26 Place of Birth: CHENNAI

**** **ARS

OTHER PERSONAL DETAILS

HEIGHT: 178 cm WEIGHT: 83 kg COLOUR OF EYES: BLACK

COLOUR OF HAIR: BLACK DISTINGUISHING MARKS: A MOLE ON RIGHT UPPER LIP

Passport

Number Place of Issue Date of Issue Date of Expiry Issuing Authority Blank Pages

Passport Office

J8084012 CHENNAI 26/08/2011 25/08/2021 21

CHENNAI

Seamans Book(CDC)

Number Place of Date of Issue Issuing Date of Remark

Issue Authority Expiry

DG

MUM 203123 MUMBAI 02/07/2012 SHIPPING 01/07/2022

MUMBAI

Certificate of Competency(COC)

Number Place of Date of Issue Issuing Date of Remark

Issue Authority Expiry

* Indicate either yes or no

GMDSSCHN16 CHENNAI 14/10/2016 MMD 13/10/2021

001433 CHENNAI

IF35676 MUMBAI 23/11/2016 DG 06/11/2021

Medical Fitness Certificate

Date of Issue Date of Expiry

Yellow Fever Vaccination

Date of Issue Date of Expiry

24-09-2012 23-09-2022

Full address: NO: 3/1 DR.RADHAKRISHNAN STREET, VIVEKANANDA NAGAR, KODUNGAIYUR, CHENNAI

Postal Code: 600118

Country: INDIA

E-mail id: acyn4f@r.postjobfree.com

Home telephone no: - 044-********

Contact/Mobile phone: +91-994*******,+91-988*******

Domestic Airport: CHENNAI International Airport: CHENNAI

Marital Status: SINGLE

Full Name of Next of Kin: PETER ANTONY Relationship: BROTHER

Address of Next of Kin: NO: 3/1 DR.RADHAKRISHNAN STREET, VIVEKANANDA NAGAR,

KODUNGAIYUR, CHENNAI

Dependents (if married)

Name Date of Birth Age Gender Relationship

* Indicate either yes or no

Details of other marine courses / STCW short course certificate

Type of Marine Course Place of Issue Number Date of Issue Date of Expiry

DIPLOMA IN NAUTICAL

SIMS/LNV/D13/2

SCIENCE-PRE SEA LONAVALA 31/07/2012

012/47

DECK COURSE

GMDSS CHENNAI GOC-C-5129 27/02/2014 26/02/2024

Basic Fire Fighting CHENNAI FPFF/8280/2012 02/09/2012

Radar Course CHENNAI ROS C/B02/01 26/12/2015

ARPA CHENNAI ARPA C/B02/10 01/01/2016

Proficiency in Survival

CHENNAI PSCRB/B531/01 15/01/2016

Craft & Rescue Boat

PSSR CHENNAI PSSR/B1441/12 23/01/2016

SIMS/LNV/ECDI

ECDIS LONAVALA 30/01/2016

S/02/2016/16

SSO CHENNAI SSO/B427/06 20/01/2016

SIMS/LNV/EFA/0

EFA LONAVALA 10/01/2012

02/2012/029

SIMS/LNV/PST/0

PST LONAVALA 17/01/2012

4/2012/69

AFF CHENNAI AFF/B526/17 04/01/2016

RMFA/B142/REO

MFA CHENNAI 04/02/2016

/B207/13

SIMS/LNV/OTFC

OTFC LONAVALA 18/08/2012

/X/2012/16

SIMS/LNV/CTFC/

CTFC LONAVALA 11/08/2012

IX/2012/16

PMA/GTFC/08/4

GTFC PONDICHERRY 25/11/2016

7/2016

PMA/STPGTO/0

GASCO PONDICHERRY 09/12/2016

2/24/2016

OFFSHORE COURSE CERTIFICATES

BOSIET MUMBAI 24/01/2015 23/01/2019

RIGGING AND MSTS ASIA -

5685524 11/02/2015 10/02/2018

SLINGING MALAYSIA

BASIC HYDROGEN BSTS- BSTS/HSE-

12/02/2015 11/02/2017

SULPHIDE TRAINING MALAYSIA 01/00849/15

* Indicate either yes or no

Employment History (Starting with Latest Sea Service)

TYPE OF VESSEL

Total Type of Deck: NAME/Type / GRT Reason for

From To Rank Company

MM/DD voyage Engine: Type / BHP / Main leaving

Engine

M.T. ALQADISIA / OIL EXECUTIVE SHIP Contract

14.03.13 27.12.13 09/15 FG D/C

TANKER/ 9343352 MANAGEMENT finished

M.T.PACIFIC POPPY / EXECUTIVE SHIP Contract

22.06.14 24.10.14 04/03 FG D/C

OIL TANKER/ 9514171 MANAGEMENT finished

M.V. EXECUTIVE EXECUTIVE

18/02/20 03/08/20 Contract

VALOUR / MPSV DP-II /

05/14 FG D/C OFFSHORE PVT

15 15 finished

9615626 LTD

Medical History

No

Have you ever signed off from a ship due to Medical reasons?

(If Yes give details)

Name of Vessel Date of Occurrence

Brief Description of Illness / Injury / Accident

No

Have you ever suffered from any ailment or disease in the past that is likely to render you

unfit for sea service or likely to endanger the health/well being of others onboard?

(If Yes give details)

No

Do you have any bodily defects or deficiencies?

(If Yes give details)

No

Are you currently suffering from any ailment or disease that is likely to render you unfit

for sea service or likely to endanger the health/well being of others onboard?

(If Yes give details)

No

Are you addicted to alcohol or drug of any kind

No

Are you suffering from an ailment that requires you to be on a long-term

treatment/medication?

(If Yes give details)

No

Have you ever been deported or banned from entering any country?

(If Yes give details)

No

Have you ever been convicted of a criminal or drug offence?

(If Yes give details)

* Indicate either yes or no

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 of competency or License issued to me has ever

been Revoked or Suspended. I also certify that my medical history contained above is true and any false

statement or undisclosed Material information about past illness or injury will disqualify me from any

employment benefits and claims.

Date; ANDREWS ASHOK KUMAR

NOTE:

* Indicate either yes or no

Contact this candidate