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
10NL2376
BIDHARUGE
FPFFR/EMA/206-15/002651
PSSR/EMA/992-15/016666
PSTR/EMA/206-15/002630
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
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