*. PERSONAL DETAILS

Surname : Mohammad First Name : Danish Middle Name

Nationality : Indian Date of Birth :04-10-1995 Place of Birth : Kolkata Weight (kg) : 65Kg Height (cm) :164cm

Post Applied for : T.M.E

Permanent Address : Present Address :

6,Nawab Abdul Latif street, 6,Nawab Abdul Latif street, kolkata kolkata

PIN Code:700016 Nearest airport : netaji subash Chandra bose int.airport Tel No / Mobile No: 988-***-**** Tel No / Mobile No: 988-***-**** Email ID: MDD2602 @gmail.com

2. PASSPORT DETAILS

Passport No. Date of

Issue Place of Issue Date of Exp. ECNR Blank Pages S3265856 19/06/2018 Kolkata 18/06/2028

3. CONTINUOUS DISCHARGE CERTIFICATE / INDOS

Seaman’s

Book (CDC) Number Date of Issue Place of Issue Expiry Date Remark CDC MUM410241 06-FEB-2020 MUMBAI 05-FEB-2030

INDOS 19EL4374 18/04/2019

4. FAMILY INFORMATION

Full Name of Next of Kin Relationship :

Mohammad Haider Father

Family Data Name Contact Number/e-mail ID

Father Mohammad Haider 789*******

Mother Samsad Begum 842*******

Sister Shama Khatoon

INTERNATIONAL MARITIME INSTITUTE

13, Knowledge Park-1,Surajpur Kasna Road,

Greater Noida.-201310

Ph no-012*-*******/2326312/2326313

5. ACADEMIC QUALIFICATION

QUALIFICATION YEAR OF PASSING PERCENTAGE BOARD/UNIVERSITY G.M.E 2020 72.5 I.M.I Gr. Noida

B.TECH (M.E) 2018 74 M.A.K.A.U.T

H.S.C. 2014 53 W.B.C.H.S.E

S.S.C. 2012 60 W.B.B.S.E

6. STCW AND OTHER COURSES

Details of Courses & Certificates Number Dt. Of

Issue

Dt. Of

Expiry

Pl. of

Issue Issued by

Basic Safety Training (STCW-

BASIC) 101*********** 01-OCT-

2019

GREATE

R NOIDA

INTERNATIONAL

MARITIME

INSTITUTE

Security Training. for Seafarer with

Designated Security

Duties(STSDSD).

101************

0

17-

DEC201

9

GREATE

R NOIDA

INTERNATIONAL

MARITIME

INSTITUTE

OTHER CERTIFICATES

Sr.No. Details of the Certificates

1. . Autodesk Autocad

9. DECLARATION

I hereby affirm that all the information provided by me in this application is true and correct to the best of my knowledge and belief; further, that no Certificate issued to me has ever been Revoked or Suspended. Date Name __ Signature

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