Engineer Security Officer

APPLICATION FORM

POST APPLIED FOR

*rd ENGINEER

Personal Information

Name

NITIN MANDAVKAR

Date & Place Of Birth

19.06.1985 / MUMBAI

Permanent Address

C-5/19/4:2, SEC 5, CBD BELAPUR, NAVI MUMBAI, PIN 400614

Contact No.

981-***-****

Next Of Kin / Relation

PL MANDAVKAR

Next Of Kin Address

C-5/19/4:2, SEC 5, CBD BELAPUR, NAVI MUMBAI, PIN 400614

Next Of Kin Cont. No.

981-***-****

Qualification

10 + 2

Tech. Qualification

BE Automobiles

Travel Documents

Document Name

Certificate No.

At

Place Of Issue

On

Issue

Till

Expiry

Passport No.

P6791781

At

THANE

On

25/01/2017

Till

24/01/2027

CDD(Indian) No.

MUM 233438

At

MUMBAI

On

04/04/2014

Till

03/04/2024

CDC(Panama) No.

P0117880

At

PANAMA

On

04/01/2017

Till

16/12/2021

COC (Panama) No.

200316449

At

PANAMA

On

04/01/2017

Till

16/12/2021

Yellow Fever No.

IOE1969

At

DAKAR

On

30/03/2008

Till

30/03/2018

STCW & Other Certificate

Sr.

Courses

Certificate No.

Issue

Expiry

Place Of Issue

1

P.S.S.R

BPMA/PSSR/4001/2016

14/07/2016

MUMBAI

2

P.S.T

SGA/PST/200*-***-****

28/07/2007

MUMBAI

3

E.F.A

SGA/EFA/200*-***-****

01/08/2007

MUMBAI

4

F.P.F.F.

FPFF/2006-0813

04/08/2007

MUMBAI

5

O.T.F.C

GET/OTFC/52/10

26/02/2010

MUMBAI

6

DCE (O.T.F.C)

OTF/V/1A-V/1

11/02/2015

19/12/2019

PANAMA

7

B.S.T

893456427

17/02/2012

PANAMA

8

A.F.F

BPMA/AFF/1470/2014

28/11/2014

MUMBAI

9

AFF-RF

RAFF/07/41/09/16

16/07/2016

15/07/2021

MUMBAI

10

P.S.C.R.B

BPMA/PSCRB/2490/2014

13/12/2014

MUMBAI

11

P.S.C.R.B-RF

BPMA/PSCRB-RF/7112/2016

15/07/2016

14/07/2021

MUMBAI

12

MEDICAL FIRST AID

BPMA/MFA/1600/2014

08/12/2014

MUMBAI

13

MEDICAL FIRST AID RF

MFA/REF07/28/10/2016

21/07/2016

20/07/2021

MUMBAI

14

SHIP SECURITY OFFICER

BPMA/SSO/2510/2014

15/11/2014

MUMBAI

15

ASST OF ENGG OFF

214517668

17/02/2012

PANAMA

16

Watch Keeping

PWK(E)-41-2010

03/02/2010

PANAMA

17

Indos No.

04 ZL 2003

09/10/2009

MUMBAI

Sea Experience

Sr

Company Name

Vessel Name

Type

NRT

GRT

Rank

From

To

1

Prime Tankers

M.T Najdiah

TNK

1210

2628

3rd ENGG

07.01.2016

07.07.2016

1

Progress Shippiing

M.T Triple Joy

TNK

1483

3098

3rd ENGG

09.01.14

15.10.14

2

Kalamis Shipping

Bosphorus King

B.C

9409

16418

Oiler

09.10.12

08.09.13

3

Shipmate

M.T Napa 1

TNK

7593

18505

Oiler

26.03.10

02.12.11

4

Bread Box Ship.

M.V Teranga

G.C

341

689

Wiper

28.12.08

03.08.09

5

Mina Star

M.V Haj Jamil

G.C

341

689

Wiper

01.03.08

27.12.08

NITIN MANDAVKAR

Date: Signature:

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