Position Applied for :

CHIEF ENGINEER.

3. MEDICAL HISTORY
(a).Have you ever signed off from a ship due to Medical reasons,(If Yes give details)						No
Name of the Vessel :			Date of Occurrence :

(b). Did you suffer or Are you Presently suffering from any disease likely to render you unfit for service at sea or likely to endanger the Health of others on board.						No
(c). Are you addicted to alcohol or drugs of any kind?						No
(d).Have You suffered from Following?
Malaria	Diabetes	Epilepsy		Nervous Disability	Hepatitis of any kind
No	No	No		No	No
(e) Did You ever undergo psychiatric treatment?						No

TRAVEL DOCUMENTS & VISA
Passport No:	Date of Issue	Place of Issue	Date of Expiry	ECNR	Blank Pages
Z 2080185	20/06/2010	THANE	23/06/2020	NR	25
U.S.VISA	31-May-2012	MUMBAI	31-May-2017

Any Other VISA

ACADEMICS & PROFESSIONAL QUALIFICATIONS
1. EDUCATIONAL BACKGROUND.
School / College	From		To		Highest Qualification attained.
(Mumbai university)	83		88		Production engineering

2. PRE SEA TRAINING / APPRENTICE SHIP.
Name of Institute / College	From	To		Grade / Marks		Type of Degree
Martek engg. works	92	93		I		Junior marine engr.

CERTIFICATIONS & COURSES

1. CDC DETAILS.

Seaman’s Book

Number

Date of Issue

Place of Issue

Date of Expiry

Indian

BY100607

21/06/2010

MUMBAI

20/06/2020

Liberian

0799860

17/09/2007

USA

17/09/2012

Panamanian

CT 708422

14/08/2006

PANAMA

31/08/2010

Marshall Islands

394394

26//10/15

2/09/2020

Bahamas

Vanuatu

2. INDOS DETAILS.

INDOS Number

99EL0840

MUI MEMBERSHIP

E - 034974

DOE -DEC 2015

3. LICENSES.

License

Grade

Number

Date of Issue

Place of Issue

Date of Expiry

Indian

CHIEF ENGR

ENG/E/279

09/10/2009

MUMBAI

2/9/2015

U.K.

CHIEF ENGR

COC0037811

15/12/2005

U.K.

2/09/2020

Singapore

Malta

CHIEF ENGR

96/99M0087N 15 NS /TTC/000233

23/11/2010

Mumbai

9/8/2015

4. DETAILS OF COURSES & CERTIFICATES.

Course Type

Number

Date of Issue

Date of Expiry

Issued By

PST

BPMA/PST/0352/2011

8/1/2011

BP MARINE

PST (RF)

PST RT/2005/3118/2016

4/6/2016

INT.MARINE ACADEMY

PSC+RB

2315

30/05/2001

MPT

PSCRB +PST (RF)

BPMA/PSCRB-RF/7211/2016

18/7/2016

BP MARINE

PSSR

PSSR-0473-98

21/12/98

HMS

PSSR (RF)

MMTI/PSSR/19505/2014

10/2/2014

MMTI

Advanced fire fighting

01106007530471

28/4/2001

SCI

Advanced fire fighting (RF)

RAFF/12/34/13/14

06/12/2014

YAK MARINE

FPFF

RF/FPFF/G-4170/2016

16/7/2016

MARINE TRAINING ACDMY

MFA

MMC/322/3202/2003

16/8/2003

MMC

MFA (RF)

MMTI/MFA(R.T)/613/2014

27/11/2014

26/11/2019

MMTI

Petroleum Tanker Safety (STPOTO)

M0087N15

16/04/1999

MCA

Chemical Tanker Safety (CHEMCO)

NS/TTC/000233

14/01/2005

MCA

Gas Tanker Safety (GASCO)

M0129H-00933

29/07/2005

MCA

Marine casualty management

MCM/060/06

15/6/06

MITSUI

IMS training

1010818120901

18/12/09

ASP

Marine environment awareness training

1060818120901

18/12/09

ASP

BOISET

Ship security officer course (SSO) Upgrade

TMI/SSO(U)/2014/25/01

10/3/2014

TOLANI

Helicopter underwater escape techniques

YAK/HUET/153/2011

17/01/2011

YAK MARINE

Hydrogen sulphide safety course

H2S /0524

31/10/2009

YAK

BASIC HYDRAULIC COURSE

354

9/4/2008

ANGLO

ADVANCED HYDRAULIC COURSE

192

12/4/08

ANGLO

Framo cargo pumping system

102

12/11/2008

ANGLO

Revalidation Course

090065

24/9/09

ANGLO

DP Maintenance course

SDB/E/01-147/2013

18/10/13

Biby marine

HIGH VOLTAGE COURSE

HVM/163

28/8/15

Biby marine

Yellow Fever

D 36505

15 OCT 2015

15 OCT 2025

MUMBAI

5. DANGEROUS CARGO ENDORSEMENTS

Types

Grade / Level

I / II

Number

Date of Issue

Place of Issue

D.O.E

Oil

COC0037811

15/12/2005

U.K.

2/09/2020

Chemical

COC0037811

15/12/2005

U.K.

2/09/2020

Liquified Gas

S.No.

Name of Owners / Manager

Name of Vessel

Type

DWT

GRT

BHP

Engine Type

UMS

Y / N

Rank

From

ANDROMEDA

Green Trader

Oil tanker

88888

21000

SULZER

6 RTA72

C/E

03/6/17

ANDROMEDA

Green Trader

Oil tanker

88888

21000

SULZER

6 RTA72

C/E

23/09/15

ANDROMEDA

Green Trader

Oil tanker

88888

21000

SULZER

6 RTA72

C/E

27/10/15

ABS Marine

Celestial

Dp2

4000

2353 X2

DAIHATSU

C/E

12/6/15

Crowely accord

Ocean centurion

Tanker

23328

9000

B & W 5S 50 MC

C/E

12/12/2014

Tag offshore

Tag -10

Dp 2/AHTS

2430

4500 X2

WARTSILA 9L32

c/e

25/5/14

Tag offshore

Tag -10

Dp 2/AHTS

2430

4500 X2

WARTSILA 9L32

c/e

17/11/13

ANDROMEDA

M.T. TRUE

suezmax

61341

14444

Man B & W

C/E

25/2/2013

ANDROMEDA

M.T. TRUE

suezmax

61341

14444

Man b& w

C/E

29/6/2012

Tag offshore

Tag - 4

Dp1/AHTS

1922

6140

c/e

15/2/12

26.

Tag offshore

Tag -9

Dp1/AHTS

1922

4582

c/e

10/12/11

Tag offshore

Nand krishna

Dp1/AHTS

1313

6128

CATERPILLAR

c/e

4/10/11

24.

Tag offshore

Tag - 4

Dp1/AHTS

1922

6140

c/e

10/6/11

ANDROMEDA

M.T. SPIKE

suezmax

61341

14444

Man b& w

C/E

29/9/2010

22.

ASP

OCEANIC COBALT

Chemical Tanker

8505

8600

Man b& w

4440kw

C/E

19/12/2009

21.

OMCI

FAIRCHEM UNICORN

Chemical Tanker

11580

8250

MAN B&W

C/E

10/03/2009

20.

GENOA

IONIAN TRADER

Chemical Tanker

24310

9660

Sulzer 5RTA58

C/E

22/11/2008

GENOA

IONIAN TRADER

Chemical Tanker

24310

9660

Sulzer 5RTA58

C/E

27/05/2008

GENOA

MERLIN CHAMPION

Chemical Tanker

21963

11100

Sulzer 6RLB66

C/E

24/09/2007

17.

GENOA

CHAMPION

ADRIATIC

Chemical Tanker

22572

11100

Sulzer 6RLA66

2/E

22/03/2007

16.

MITSUI

NAVIX AZALEA

VLCC

146745

28000

MAN B&W

2/E

27/06/2006

15.

GENOA

CHAMPION PIONEER

TANKER

22572

9220

B&W 5l60 MC

2/E

03/12/2005

14.

WORLD TANKER

KOLOSSI

suezmax

137728

23200

Mitsubishi

7UEC75LSII

2/E

22/02/2004

13.

WORLD TANKER

KOLOSSI

suezmax

137728

23200

Mitsubishi

7UEC75LSII

2/E

13/02/2003

12.

WORLD WIDE

NILE

suezmax

153407

31290

Sulzer

2/E

01/12/2003

11.

HMS

ASTYPALEA

TANKER

16977

11200

Sulzer

7RND76

2/E

22/03/2002

HMS

ROSETTA

TANKER

19351

12500

B & W 6k74 EF

2/E

11/06/2001

HMS

MICHEL IULIANO

TANKER

12500

10099

Sulzer 4RTA76

2/E

28/10/2000

HMS

Liano

TANKER

17381

12600

B& W 6K74EF

3/E

28-aug-99

HMS

Yellow star

TANKER

23721

14000

Sulzer 7 RND 76

3/E

7-apr-98

HMS

White star

TANKER

18092

12000

Sulzer 7 RND 68

3/E

14-feb-97

HMS

Nevada

TANKER

29465

13100

B&W 7167FC

3/E

10-apr-96

HMS

Obo victory

TANKER

32607

16000

B&W 6180GFC

3/E

25-jun-95

HMS

Atlantic sea

TANKER

22126

14000

Sulzer 7 RND 76

3/E

13-Aug-94

HMS

Green star

TANKER

15027

11550

Sulzer 7 RND 68

4/E

28-oct-93

HMS

Blue star

TANKER

15027

11550

Sulzer 7 RND 68

J/E

11-sep-92

MISCELLANEOUS
1. DECK OFFICERS.
Bulk: Type of cargo carried	GRAIN
Product: Type of cargo carried	VEGETABLE OIL
Chemical: Type of cargo carried	BENZENE,NITRATE,RBD OLIEN,PALM OILSTEARIN,KERNEL OIL,SOYABEAN OIL,MOLASES
Tanker: Type of pumps	FRAMO/COP
2. ENGINEERS.
Automation. (Type)	NORCONTROL, HONEYWELL,KONSBERG
Cranes. (Type)	SAMSUNG, MITSUBHISHI
Dp systems	Converteam, konsberg
3.C/E RANK EXPERIENCE ON DIFF.TYPE VESSELS
DP2 /AHTS VESSELS.		191 Days (6.4 Months)
DP1 /AHTS VESSELS		172 Days (5 .75 Months)
Total offshore experience		363days (12.1months)
Total tanker experience		1311 days (43.7months)
4. GENERAL TRADING AREA OF VESSELS
ALL OVER THE WORLD / Nigeria
5. OIL MAJOR INSPECTIONS.
CDI
Port State Control. (Please Specify)		USCG/AMSA/EU
Others. (Please Specify)		SHELL / TOTAL
6. DRY DOCKING EXPERIENCE.
		YES/ FOUR TIMES

I hereby affirm that all this information provided by me in this application is true and correct to the best of my knowledge and belief; further, that no Certificate of competency or License issued to me has ever been Revoked or Suspended. I also certify that my medical history contained above is True and any false statement or undisclosed material information about past illness or injury will disqualify me from any employment benefits and claims.

Date___12/2/2018________ Rank_ C/E Signature of Seaman ___________________