Grill Cooks High School

Last updated date : **/**/**** **:** PM Date : **-Jul-2019

Seafarer Profile

Personal Details

Name : MANGAL SINGH

INDoS No. : 16ZL9702

Discipline : Nautical

Gender : MALE

Date of Birth : 12/11/1996

Place of Birth : ETAH Birth State : U.P

Birth Country : INDIA Nationality : INDIAN

Address Details

Present Address Permanent Address

Address : VILL-NAGLA BUDHU Address : VILL-NAGLA BUDHU

: POST-REETPUR : POST-REETPUR

: :

City : ETAH City : NAGLA BUDHU

Pin : 206126 Pin : 206126

State : U.P State : Uttar Pradesh

Country : INDIA Country : INDIA

Telephone No. : Telephone No. : +918*********

Mobile No. :+919*********

Email Id : *************@*****.*** *****************@*****.***

Physical Details

Height (in Cms) : 167 Hair Color : BLACK

Eye Color : BLACK Complexion : FAIR

Identification : WOUND IN LEFT ARM

Education Details

1 . Education Level : 10+2 (HSC/Intermediate/equivalent)

Main Subjects : B SCIENCE

Certificate No. : Year of Passing : 2013

PCM Mark : 60 English Mark : 045

Result /Grade : SECON

Name of University : BOARD OF HIGH SCHOOL AND INTERMEDIATE EDUCATION UP

Name of Institution : KISAN I C BHOOLPUR ETAWAH

Institute Address : ALLAHABAD

Total no of record in Education Details : 1

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Modular Course Details

1 . Course Name : Personal Safety & Social Responsibilities

Course Name : Personal Safety & Social Responsibilities

Training Institute : Centre for Maritime Education & Training (Lucknow)

STCW Code : A-VI/1-4

Attended From : 12/05/2018 Attended To : 14/05/2018

Certificate No. : CMETL/PSSR/789/12664

Date of Issue : Valid Upto :

2 . Course Name : Fire Prevention & Fire Fighting

Course Name : Fire Prevention & Fire Fighting

Training Institute : Centre for Maritime Education & Training (Lucknow)

STCW Code : A-VI/1-2

Attended From : 16/05/2018 Attended To : 18/05/2018

Certificate No. : CMETL/FPFF/824/12488

Date of Issue : 18/05/2018 Valid Upto :

3 . Course Name : Personal Survival Techniques

Course Name : Personal Survival Techniques

Training Institute : Centre for Maritime Education & Training (Lucknow)

STCW Code : A-VI/1-1

Attended From : 19/05/2018 Attended To : 21/05/2018

Certificate No. : CMETL/PST/778/10708

Date of Issue : 21/05/2018 Valid Upto :

4 . Course Name : Elementary First Aid

Course Name : Elementary First Aid

Training Institute : Centre for Maritime Education & Training (Lucknow)

STCW Code : A-VI/1-3

Attended From : 25/05/2018 Attended To : 26/05/2018

Certificate No. : CMETL/EFA/864/11723

Date of Issue : 26/05/2018 Valid Upto :

5 . Course Name : Security Trng. for Seafarer with Designated Security Duties

Course Name : Security Trng. for Seafarer with Designated Security Duties

Training Institute : Centre for Maritime Education & Training (Lucknow)

STCW Code :

Attended From : 27/05/2018 Attended To : 29/05/2018

Certificate No. : CMETL/FPFF/824/12488

Date of Issue : Valid Upto :

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Total no of record in Modular Course 5

Authorised Documents

1 . Document Type : Passport

Document Type : Passport

Document Number : R9835353 Issued Date : 01/05/2018

Valid Upto : 30/04/2028 Issued At : LUCKNOW

2 . Document Type : CDC

Document Type : CDC

Document Number : MUM 321371 Issued Date : 17/07/2018

Valid Upto : 16/07/2028 Issued At : MUMBAI

Total no of record in Authorised Documents : 2

DECLARATION TO BE MADE BY CANDIDATE :

I hereby declare that the particulars entered in the form are correct and true to the best of my knowledge and belief and that the

papers enumerated in this form are true and genuine documents given and signed by the person whose names appears on them. I

further declare that Seagoing service information entered is a true and correct account of my sea-going service without exception and

I make this declaration conscientiously believing the same to be true. The documents in original will be presented to the examiner at

the time of taking oral examination or at an earlier time when asked by the department.

Signature of the candidate

Date :

This is an electronically generated document hence it does not require any signature of DGS Officials.

Report generated on : 05/07/2019 1.56 PM Page 3 of 3

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