Form Exn: 02 (Pak)
APPLICATION
FOR
MASTER MARINER AND DECK OFFICERS EXAMINATIONS
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Note: - Application should be made at Mercantile Department Karachi, it should be submitted along
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"'tin'ut"
ii'r'o't
Name in Full
Nationality
Mobile No
Seaman Book No.
p.*ious Certificates
Tirle of certificate
10
Resident Address
(B1q4!g1tq0
Place of Birth
Date of Birth
nf
within
licant
Particulars of
A
""1x,tJi"Io;::ffiLff:ltfi:1x1'jljilrsfl1'fi?,i:re-examination)
Certificate
Number
(issued in Pakistan or elsewhere, if none; state so
End.
Date of Expiry
Date of Issue
No.
State whether at anY time
suspended or cancelled and ifso: (a) By what Court of AuthoritY
(b)
Date
(c) Cause
(a)
Class
(b)
(c)
[I / III / IV
Please delete as appropriate
Fl,xamination now requ ired
Port at which Applicant desires to
Please tick the appropriate box;
be examined and Date
Class
Class-II
Class-1
Orals
BlockA BlockB
Itrtr
tr
(D)
Orals
III
Written
Class
Orals
tr
tr
IV
Written
utr
Orals
Certificate of Principal Officer
The Declaration (F) was signed in my presence, and the Fee of Rs.
20.,....
KARACHI /
was received by me.
Principal Officer
Mercantile Marine Department, Karachi
er'tificate o f Exa mtner
E
Written
Sight Test
Date
Letter
Lantern
Test
Test
A
Class III
Block
Block B
Class
Oral
IV
Signaling
Additional
Certificate of
sea service
Competency
to be issued
(If any)
20......
Examiner
Candidate
Declaration to be made
or procures
makes,
person
who
ft4y.n XOftCn)-Any
to be made, or assists in making, any false representation for the
of Competency will render himself liable to hea\ry penalties'
person,
a
certificate
other
any
o,r,ose of obtaining for himself or
Sections (A), (B) and (C) ofthis Form are correct and
my knowledge and belief. And I make this Declaration conscientiously believing the
I hereby declare that the particulars contained in
true to the best of
same to be true.
20......
Page
I
of
1
Signature of Candidate
Effective date: 01 .07.2021
Rev'.0212021