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BIO - DATA

Name: Post: O/S

DOCUMENTS NUMBER DATE OF ISSUE PLACE OF ISSUE VALIDITY

PASSPORT R3310188 26-JUL-2017 COCHIN 25-JUL-2027

CDC MUM274092 27-APR-2017 MUMBAI 26-ARP-2027

INDOS 16GL3193 28 JUL 2016 MUMBAI UNLIMITED

YELLOW FEVER L5240-1 29 JUL 2017 COCHIN 18 JUL 2027 WATCH KEEPING WKN20000919 20-FEB 2020 MUMBAI UNLIMITED COURCE NUMBER DATE OF ISSUE PLACE OF ISSUE VALIDITY P. S. S. R PSSR/PAGP/EMA/001992 25 AUG-2016 COCHIN UNLIMITED P. S. T PST/PSGP/EMA/001992 22 AUG 2016 COCHIN UNLIMITED F. P. F. F FPFF/PSGP/EMA/001992 18 AUG 2016 COCHIN UNLIMITED E.F.A EFA/PSGP/EMA/001992 29 AUG 2016 COCHIN UNLIMITED S.T.S.D.S.D STS/PSGP/EM001992 22 AUG 2016 COCHIN UNLIMITED A.U.G MUM/AUG/V067/1172 22-SEP 2017 MUMBAI UNLIMITED O.C.T.C.O OCC/PSGP/EMA/001992 24 SEP 2016 COCHIN UNLIMITED OIL..D.C.E CMMI/OIL/18/38129 08 SEP 2018 MUMBAI 07-SEP 2023 CHEM.D.C.E CMMI/CHEM/18/33 08 SEP 2018 MUMBAI 07 SEP 2023 PRE-SEA PSGP/EMA/001992 17 DEC 2016 COCHIN UNLIMITED SIGNATURE

DATE:

PLACE: Mumbai

Present Address

Lavagothi Biddaruge Pallessery Kendiparty Welfare society Kendiparty Village, Minicoy Island 160/162, Samuel Street, U.T.Of.Lakshadweep - 682559 Mumbai - 400009

Contact No: 854-***-****, 999-***-**** Contact No: 23476265/23444895 Date Of Birth: 07-DEC-1994 Email: ***************@*****.*** Place Of Birth: Minicoy, Lakshadweep

Next Of Kin: Kadeeja Lavagothi Relation: Mother

NAME OF VESSEL

TYPEOFSHIP GRT IMO RANK FROM TO PERIOD

UBAIDULLA LDCL CARGO

SHIP

739-***-**** TSM 17-FEB-20 6M 23D

COMPANY

SAFIYUDDEEN LAVAGOTHI

BIDDARUGE

Permanent Address

SAFIYUDDEEN LAVAGOTHI BIDDARUGE

25-JUL-19

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