APPLICATION FORM

PERSONNEL DATA UPDATE FORM

Dear sirs,

I hereby apply for a position as and I am ready to join from Following is the list of all certificates and courses I have completed FULL NAME AS PER PASSPORT

Surname- Firstname SAFWAAN Middle name KORHEEGE

Rank- 3RD OFFICER D.O.B 20-10-1991 P.O.B MINICOY

Nationality- Indian Religion- Muslim

NUMBER ISSUED DATE EXPIRY DATE PLACE

J8106557 07.10.2011 06.10.2021 COCHIN

MUM187828 11.05.2011 10.05.2021 MUMBAI

IF-34012 29.02.2016 01.02.2021 MUMBAI

28.11.2014 27.11.2024 CHENNAI

10NL2376

PERMANENT ADDRESS PRESENT ADDRESS

NEXT OF KIN

NAME D.O.B PP/NO ISSUED / VALIDITY

FATHER 18.10.1962

MOTHER 17.12.1967

BROTHER 29.08.1988

SISTER 28.01.1999

COURSE CERT . NO . ISSUED DATE PLACE

FPFF COCHIN

PSSR COCHIN

PST COCHIN

EFA MUMBAI

AFF COCHIN

MFA COCHIN

PSCRB COCHIN

ROSC COCHIN

ARPA COCHIN

ECDIS COCHIN

SSO COCHIN

OTFC MUMBAI

CTFC MUMBAI

GTFC MUMBAI

PASSENGER SHIP FAMILIARISATION COURSE MUMBAI

INDOS NO.

YELLOW FEVER COCHIN

OTHERS

Type of

vessel

M.T GURU GOBIND OIL 9 MONTHS

SINGH TANKER 1 DAY

M.T SWARNA OIL 9 MONTHS

KALASH TANKER 11 DAYS

2558 80130 DECK CADET 28.06.2012 28.03.2013

3531 29845 DECK CADET 04.07.2013 14.04.2014

6 MONTHS 16

3RD OFFICER 15.04.2016 31.10.2016 DAYS

PASSENGER 6 MONTHS

3262 2ND OFFICER 21.02.2017 23.08.2017 2 DAYS

LAKSHADWEEP

DEVELOPMENT

CORPOPRATION

LTD

LAKSHADWEEP

DEVELOPMENT

CORPOPRATION

LTD

M.V ARABIAN SEA 3452 PASSENGER 3261

M.V LAKSHADWEEP SEA 3453

111***********

111***********

10NL2376

BIDHARUGE

FPFFR/EMA/206-15/002651

PSSR/EMA/992-15/016666

PSTR/EMA/206-15/002630

111***********

PSRB R/EMA/132-15/001734

GOC-C-5757

HUSSAIN

KORHEEGE BIDHARUGE

RAMMEDU VILLAGE

MINICOY ISLAND 682559

U.T.OF LAKSHADWEEP

TEL;048**-******, 940*******

MISKUIDHORUGE HOUSE

08.12.2016

NAME/ RELATION MR. HUSSAIN BODUGE

02.02.2015

28.03.2015

AYSHA

ROSC/EMA/77-15/000833

ARPA/EMA/77-15/000827

ECDIS/EMA/60-15/000597

SSO/EMA/I/43-15/001630

03.02.2015

28.07.2011

23.01.2015

28.02.2015

DOCCUMENTS

PASSPORT

2MFG COC INDIAN)

AFF R/EMA/130-15/001557

MFA/EMA/460-16/006831

21.02.2015

03.02.2015

11.01.2011

02.02.2015

17.01.2015

U.T.OF LAKSHADWEEP

TEL;940*******

ADDRESS: BODUGE RAMMEDU VILLAGE, MINICOY ISLAND U.T OF LAKSHADWEEP PIN. 682559 SIDDIQUE

SUMAIYAH

RECORD OF PREVIOUS SERVICE

111***********

111***********

16.07.2011

20.06.2011

SCI

CDC ( INDIA )

GOC (INDIAN)

INDOS

22.07.2011

18.11.2011

SCI

PALLISSERY VILLAGE

MINICOY ISLAND 682559

M.V LAGOONS

LAKSHADWEEP

DEVELOPMENT

CORPOPRATION

LTD

3984 PASSENGER 5938 2ND OFFICER 31.01.2018 31.07.2018 6 MONTHS M.V CORALS

LAKSHADWEEP

DEVELOPMENT

CORPOPRATION

LTD

3983 PASSENGER 5939 2ND OFFICER 11.01.2019 29.07.2019 6 MONTHS 18 DAYS

Vessel Company OFFICIAL NO G.R.T Rank Sign-on Sign-off M/D

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