Seaman Adress nawada bihar

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€ Y=) da) are sd Orel NZ)

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PERSONAL DETAILS

INDOS NO:19ZN0321

Name Gulshan kumar

Rank applied for os

Father name Dinesh singh

Mother name Ritu devi

Date of birth 01/01/2001

Nationality Indian

Contact No 993*******

e-mail adress ********************@*****.***

Blood group B+

Address At-dola,po-dheodha,ps-pakribarawan,distt-n

Course of study year School/collage/board stream results

High school 2019 Dr chandra deo yaday All subjects 49.6%

+2H/S belauri,

lakhisarai

STCW COURCES DETAILS

Course name Certificate number Date of issue Place of issue

STSDSD 1010021481922711 03/12/2019 Varanasi

PST 101************ 29/11/2019 Varanasi

FPFF 101************ 29/112019 Varanasi

EFA 101************ 29/11/2019 Varanasi

PSSR 101************ 29/11/2019 Varanasi

PASSPORT DETAILS

Doc Passport Date of issue Date of expiry Place of issue

number

PASSPORT 720*****-**/08/2019 04/08/2029 PATNA

CDC DEAILS

cbc Number Date of issue date of expiry Place of issue

INDIAN CDC MUM414793 05/03/2020 03/03/2030 MUMBAI

SEA SERVICE EXPERIENCE

Vasselname Grt Signin Sign off RANK TYPE

TULIP 1 127 20/07/2021 19/07/2022 os TOWING

hereby declare that the above information mentioned is true and filled under my knowledge

Thank you.

SIGNATURE:

DATE:-

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