*Post Applied : *Available Date : Picture Upload :
Name As Per Seamen Service Book / CDC
*First Name Middle Name *Last (or) Surname
*Date Of Birth (DD-MM-YY) *Place Of Birth *Nationality *Contact Number
Address :
NEXT OF KIN DETAILS
Full Name Relationship Contact Number
PASSPORT DETAILS
Passport No Issue Date Expiry Date Issue Place
VALID VISA
    
SEAMEN SERVICE BOOK (SSB) / CDC DETAILS
SSB / CDC No Issue Date Expiry Date Issue Place
IF OTHER
    
ACADEMIC QUALIFICATION: (ENTER DEGREE/ DIPLOMA/ SCHOOL)
Diploma/ Degree/ Certificate University/College/School Year Passed Grade
CERTIFICATE OF COMPETENCY / LICENSE AND GMDSS
Authority
Grade
Certificate No
Issue Date (DD-MM-YY)
Expiry Date (DD-MM-YY)
Issue Place
National
Endorsement
GMDSS
Other CoC


STCW BASIC COURSES & OTHER CERTIFICATES
Certificates
Certificate No.
Date Of Issue (DD-MM-YY)
Date Of Issue (DD-MM-YY)
Place Of Issue
Personal Survival Techniques
Elementary First Aid / Medical First Aid
Basic Fire Fighting / Fire Prevention & Fire Fighting
Personal Safety and Social Responsibilities
Tanker Familiarization Certificate
Watch Keeping Certificate (ENGINE)
Watch Keeping Certificate (DECK)
Yellow Fever
Medical Fitness Certificate
STCW ADVANCE COURSES & OTHER CERTIFICATES
Certificates
Certificate No.
Date Of Issue (DD-MM-YY)
Date Of Issue (DD-MM-YY)
Place Of Issue
Proficiency in Survival Craft & Rescue Boats
Advance Training in Fire Fighting
Advance Training Program Oil Tanker Operations
Ship Master Medical Care
Efficient Deck Hand
ISPS / SSO / SSA (Ship Security)
Bridge Team Management / BRM Certificate
Radar Simulator / ARPA
Dangerous Cargo Endorsement
ECDIS


SEA SERVICE RECORD/EXPERIENCE: (START FROM YOUR LAST VESSEL)
Company Name

Vessel Name

Vessel Type

GRT/ NRT

Engine/ BHP

Rank Position

Actual Sea Service
From (DD-MM-YY)
TO (DD-MM-YY)
Total Month

Last Vessel Salary in USD :
Minimum Salary Expected in USD
DECLARATION : I do hereby declare that the given Information / Record is true to the best of my knowledge and belief.
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