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Identity Documents
Document Number* Country* Issue Place* Issue Date* Expiry Date*
Passport
Seaman's Book/CDC Addmore
Visa
  Yes/No Issue Date Expiry Date
Do you hold a US Visa 'C1 D'? Yes No
Do you hold a any other visa ? Yes No
Do you hold an Australian Visa? Yes No
 
  Yes/No* if YES, please state the country and reasons*
Have you ever been rejected for any visa applied for?
Next of Kin Information
Educational Background
  Name From Year To Year Country Highest Qualification Attained
School
College
Pre Sea Training
Other Qualifications
National Certificate of Competency
Class/Grade Certificate Number Country of Issue Issue Date Expiry Date
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Flag State Equivalent Certificate of Competency
Class Certificate Number Country of Issue Issue Date Expiry Date
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National Dangerous Cargo Endorsements
  Type of Endorsement Certificate Number Country of Issue Issue Date Expiry Date
Petroleum
Liquified Gas
Chemicals
Flag State Equivalent Dangerous Cargo Endorsements
  Type of Endorsement Certificate Number Country of Issue Issue Date Expiry Date
Petroleum
Liquified Gas
Chemicals
Certificates (STCW, BOSIET, Value Added)
License/Certificate Certificate Number Country of Issue Issue Date Expiry Date
Addmore
DETAILS OF COURSES & CERTIFICATES  FOR OFFICERS
Courses Certificate Number Issue By Issue Date Expiry Date
Advanced  Fire Fighting  (AFF)
Medical First Aid  (MFA) / Medicare 
Proficiency in Survival Craft & Rescue Boat  (PSCRB)
Personal Survival & Social Responsibility (PSSR)
SSO (Ship Security Officers Course)
ECDIS
BTM (Renewed every 5 years)
ARPA (Automatic Radar Plotting Aid)
GMDSS
Radar Observer / RANSCO Simulator
GMDSS Endorsement
Oil Tanker Familiarization (OTFC) / TASCO
DCE Oil – Support / Operation / Management
Chemical Tanker Familiarization (CTFC) / CHEMCO
DCE Chemical – Support / Operation / Management
Specialized Training Programme On Oil Tanker Operations (STPOTO)
Framo Course
Revalidation Course for Deck / Engine Officers
Refresher & Up Gradation Course for Deck / Engine Officers Addmore
DETAILS OF COURSES & CERTIFICATES  FOR Ratings
Courses Certificate Number Issue By Issue Date Expiry Date
FIRE PREVENTION & FIRE FIGHTING (FPFF)
ELEMENTARY FIRST AID (EFA)
Personal Survival Technique (PST)
Personal Survival & Social Responsibility (PSSR)
ISPS Course
Oil Tanker Familiarization (OTFC)
DCE Oil – Support
Chemical Tanker Familiarization (CTFC)
DCE Chemical – Support
Watch Keeping Certificate Ratings (Deck/Engine)
Pump Man Course
Cookery Course
MMD Cookery Certificate
Fitter Course / Class Cert
Ship Safety Officers Course / Risk Assessment
Ship Maneuvring Simulator
BRM / MRM / BERM (Renewed every 5 years)
Electrical/Electronics for Marine Engineers – Basic / Advance Addmore
Sea Service Record
Vessel Name Vessel Type Ship Operation GRT Engine Start Date End Date Rank
Addmore
Additional Information




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