APPLICATION FORM
Position
Position applied for JUNIOR ENGINE WATCH KEEPING OFFICER
Lowest rank
acceptable
ENGINE CADET
Preferred vessel type Bulk Carrier
Readiness date
Personal Details
Last name Sugumaran First name Jagan Prakash
Middle name Gender M
Date of birth 19/May/1995 Nationality Indian
Country of
Residence
India City of Residence Chengalpattu, Chennai
Phone Mobile 994*******
Zip code 603211 E-mail **************@*****.***
Address No.28 perumal koil 3rd cross street, Kilambakkam West, Urapakkam,Chengalpattu District,Tamil nadu, INDIA. Identity Documents
Passport number N2142578
Seaman book
number
CHN 102509
Passport issue date 05/Aug/2015
Seaman book issue
date
30/Jun/2016
Passport expiry date 04/Aug/2025
Seaman book expiry
date
29/Jun/2026
Seaman book issue
country
India
OR ASSISTANT 4TH ENGINEER
ANY TYPE PROVIDED THE OPPURTUNITY
IMMEDIATE READINESS
Education
Type Name From year To year Qualification attained High school Sita Devi Garodia Hindu Vidhyalaya Higher secondary School 2010 2012 12th class High school NEELAN MATRICULATION SCHOOL 1998 2010 10th CLASS University AMET UNIVERSITY 2012 2016 B.E(Marine Engineering) Certificates
Category Certificate Number Issuing
Authority Issued Expiry
Place of
issue
STCW MEDICAL FIRST AID A-VI/4 1-3 MFA/B1060/10 India 12/Apr/2018 HIMT CHENNAI
STCW PERSONAL SAFETY & SOCIAL RESPONSIBILITY A-
VI/1-4 PSSR/B636/09 India 16/Sep/2015
AMET
CHENNAI
STCW PROFICIENCY SURVIVAL CRAFT AND RESCUE BOATS
A-VI/2 1-4 PSCRB/B634/12 India 20/Apr/2018
HIMT
CHENNAI
STCW PERSONAL SURVIVAL TECHNIQUES (STCW A-VI/1-1) PST/B696/07 India 23/Sep/2015 AMET CHENNAI
STCW ADVANCED FIREFIGHTING A-VI/3 AFF/B622/10 India 28/Apr/2018 HIMT CHENNAI
STCW FIRE PREVENTION FIRE FIGHTING A-VI/1-2 FPFF/B581/09 India 15/Jul/2015 AMET CHENNAI
SIMULATOR ENGINE SIMULATOR COURSE ERS/B661/11 India 02/May/2018 HIMT CHENNAI
STCW
ADVANCED HIGH VOLTAGE COURSE HV-O/B107/05 India 07/May/2018 HIMT
CHENNAI
VESSEL TYPE OIL TANKER FAMILIARIZATION TFC-
COM/B44/17 India 27/May/2017
HIMT
CHENNAI
VESSEL TYPE CHEMICAL TANKER FAMILIARIZATION TFC-
COM/B44/17 India 27/May/2017
HIMT
CHENNAI
Licences
Licence Capacity Rank Limitation Issuing
Authority Issued Expiry Number
Place of
issue
CERT OF
COMPETENCY
Officer In Charge Of
Engineering Watch
World wide 3000 kw
or more India 28/May/2019
95Z-
29814 KOLKATA
Visas
Country Number Type Issued Expiry Place of issue
United States of America L6400416 US VISA C1/D 12/Aug/2016 10/Aug/2021 CHENNAI Vaccinations
Class
4
Number Type Issued Expires Place of issue
029/020 YELLOW FEVER 08/Aug/2016 07/Aug/2026 CHENNAI Sea Services
Rank Joined Signed off Period Vessel Type Engine GRT KW Owner / Manager TME 28/Jul/2017 28/Mar/2018 0Y 8M
0D
SAFESEA
NEHA 2
Bulk
Carrier
MAN B&W
6S50MC-C 31,144 9,480
NOAH SHIP
MANAGEMENT
JOFF 12/Nov/2019 26/Feb/2020 0Y 3M
15D
SAFESEA
NEHA 2
Bulk
Carrier
MAN B&W
6S50MC-C 31,144 9,480
NOAH SHIP
MANAGEMENT
Experience
Vessel Type Period Voyages
EXPERIENCE BY VESSEL
Bulk Dry 0Y 11M 17D 2
Subtotal: 0Y 11M 17D 2
Total: 0Y 11M 17D 2
Rank Period Voyages
EXPERIENCE BY RANK
0Y 3M 15D 1
TME 0Y 8M 0D 1
Subtotal: 0Y 11M 17D 2
Total: 0Y 11M 17D 2
Declaration
Signature: Date:
JUNIOR ENGINE WATCH KEEPING OFFICER Sugumaran, Jagan Prakash ASST
4th
ASSISTANT 4TH ENGINEER