APPLICATION FORM
Post Applied for 2nd Mate DPO
Date of Application
Willing to WORK IN LOWER RANK
NO
P H O TO G R A P H
Name as per Passport
(First Name)
(Mid. Name)
Last (or) Surname
Sandeep
Passport No.:
F-7283848
Yadav
Date of Birth
Place of Birth
Nationality
31-Dec-1976
Delhi
Indian
Issue Dt.
12-Apr-2006
Issue Place
Delhi
Exp. Date
11-Apr-2016
INDOS No. :00NL0682
Income Tax PAN No. :
Permanent Address :
Saneh Kunj
L-75,Libaspur Near Rama Sweets Delhi, India-
Pin
ECNR YES/NO
Present Address / Correspondence address :
Saneh Kunj
L-75,Libaspur Near Rama Sweets Delhi, India-
:110042
Pin
110042
:
Tel : 011-27831057
Airport :IGI Delhi
e-mail : 1. yadavsandi@yahoo.co.in
Nearest
Tel :
011-27831057
MOB: 1. 9999637722
2.
2. yadavsandi@indiatimes.com
Academic Qualification : (Enter Degree /Diploma / School)
Degree
University
Yr. Passed
Date Commenced
Grade
Date Completed
PRE-SEA TRAINING
Institute
Apprenticeship with
Highest Competency
Authority
Indian
U.K.
Panama
Singapore
Sri Lanka
Liberian
CDC Details:Document
CDC (Indian)
CDC
CDC
Certificate Now Held
Comp. Cert.
2nd Mate ( FG )
CDC NUMBER
CL 52299
Cert. No.
IF-17594
Date of Issue
21-Mar-2005
Date of Issue
25-Apr-2005
STCW COURSES ATTENDED AND CERTIFICATES HELD
Course/Certificate
Certificate No.
02544
Personal Survival Techniques /PSC & Rescue boat
53/5357/00479
Elementary/Medical First A/c/ Ship Master’s
Medicare
02313
Fire Prevention & Fire Fighting /AFF
Pr000122
P.S.S.R.
MMD Watch Keeping Certificate (for crew)
Revalidation
ISPS-SSO
BT06181
BRM/BTM Certificate
Place of
Issue
Mumbai
Place of Issue
Kolkata
Date
Valid Till
25-Mar-2015
Valid Till
24-Apr-2015
10/12/2004
21/01/2000
Place issued
IIPM /Kolkata
Fosma / Delhi
5/11/2004
05/04/2000
IIPM /Kolkata
ARI / Delhi
16/11/2006
ARI / Delhi
Valid Till
L/75/03
k/60/03
27/09/2004
21/09/2004
Sensea / Kolkata
Sensea / Kolkata
12882
Goc/mmd/mum/16
099
28/10/2004
30/10/2009
Delhi /GOV IND
Mumbai /MMD
27/10/2014
27/10/2014
Oil Tanker Familiarization
Chemical Tanker Familiarization
TASCO
CHEMCO / GASCO
Oil Tanker DCE
Chemical Tanker DCE
Yellow Fever Vaccination Details
GW 17/8
03/11/2001
RSA
02/11/2011
DPO
11337
16/04/2010
The Nautical
Institute.UK
Radar Simulator ARPA
Radar Observer/RANSCO
RCC/RT
G.M.D.S.S. (IND)
G.M.D.S.S. ENDORSEMENT (IND)
TAR Book issued (for trainee ratings)
Sailing Experience : (Starting with most recent)
Actual Sea Service
From Date
To Date
dd mm yy dd mm
yy
‫٭‬
Bibby ship
management
Bourbon
Hamelin
Greatoffshore
Malaviya
Seven
Greatoffshore
Malaviya
Thirty
Greatoffshore
Malaviya
Thirty
Greatoffshore
Malaviya
Thirty
Dohle
danautic
Cenmar
M.T.
havildar
abdul hamid
M.T.
cewave
2/O
DPO
2/OFF
Tr.DP
O
2/OFF
Tr.DP
O
2/OFF
Tr.DP
O
2/OFF
Tr.DP
O
DP-2
PSV
2/OFF
Crude
oil
2/OFF
Crude
oil
DP-2
PSV
DP-1
PSV
DP-1
PSV
DP-1
PSV
13
06
10
21
09
10
31
10
09
11
02
10
13
08
09
13
10
09
3 mnth
8 days
3 mnth
12 days
2 mnth
06
03
09
29
05
09
05
11
08
16
01
09
03
04
08
09
06
08
2 mnth
8 days
19
11
07
16
01
08
1 mnth
27 days
2 mnth
24 days
2 mnth
12 days
Great Eastern
M.T. Jaglata
Great Eastern
M.T.
Jaglavanya
Great Easte
M.T. Jaglok
SUMMARY :
Master/Ch Engineer :
Ch Off/2nd Eng :
30
11
06
23
06
07
6 mnth
27 days
Crude
oil
04
05
06
07
09
06
4 mnth
3 days
Crude
oil
13
11
05
13
02
06
3 mnth
2/OFF
Crude
oil
2/OFF
Ad 2/O
(as applicable) Mention total period of sea Services in months :
2nd Off/3rd/Eng :29 mnths
El Off :
3rd Off/ 4th Eng : 9 mnths
Fitter :
Are you computer literate
If yes give details
No
PLEASE GIVE REFERENCE OF ATLEAST TWO PERSONS (not relatives) :
Name
Full Address
1.
Mr. Rajiv yadav
Flat no.83 gate-2 Mig Flats West Punjabi
Bagh
2.
Tel. (Office)
Tel. (Residence)
Mr. Jasjit Singh
NEXT OF KIN DETAILS :
Name: Satish Yadav
Relationship: Brother
Address:
Tel. :
Saneh Kunj
L-75,Libaspur Near Rama Sweets Delhi, India- 110042
9212433319
Name of spouse (if married) and details of dependents
Name
Relationship
Neelam Yadav
Suhana Yadav
Wife
Daughter
Date of Birth
15-Sep-1983
21-Jan-2006
Passport No.
Date of
issue
Date of
Expiry
BANK PARTICULARS :
Bank Name :
Bank A/c No. :
Royal Bank Scotland
1517655
NRE :
Branch:RBS Bank NV,Sakhar Bhavan
Nariman Point,Mumbai - Maharashtra
IFSC CODE :RBS0200001
SWIFT CODE : ABNAINBB
DD Payable at :
Available to join from :
Boiler suit size
Safety Shoe size
1
Rady to join
: XXL
: 10
I do hereby declare that all information furnished above is to the best of my knowledge and belief .
SIGNATURE