FORM 1

APPLICATION FORM FOR

CONTINUOUS DISCHARGE CERTIFICATE-CUM-SEAFARE'S IDENTITY
DOCUMENT (CDC) FROM TRAINING INSTITUTES CONDUCTING PRE-SEA
COURSES APPROVED BY DIRECTORATE GENERAL OF SHIPPING
PAGE # 1 OF 2
SMO(M)/2009/13501 Application No :
05-AUG-09 Application Date :
AADITYA SHRIRAM Seafarer's Name :
M Gender :
21-JAN-92 Date of Birth :
Indian Nationality :
--- Valid Passport No :
--- Place of Issue :
Date of Issue :
SHRIRAM THIAGARAJAN Father's Name :
135
27/14
EAST COAST ROAD
SCHOOL VIEW ROAD, FIRST LANE
KANATHUR
R.K.NAGAR, MANDAVELI
603112
600028
CHENNAI
CHENNAI
TAMILNADU
TAMILNADU
044-27472804
044-24643435
aaditya822@gmail.com
aaditya822@gmail.com
ABIRAMIPURAM
ABIRAMIPURAM
Personal Details
Correspondence Address
Permanent Address
House No. :
House No. :
Village/Post :
Village/Post :
Street :
Street :
PIN :
PIN :
District :
District :
State :
State :
Phone :
Phone :
Email Id :
Email Id :
Near Police Station :
Near Police Station :
Academy.of.Maritime.Education.&.Training
822B
27-JUL-09
Institute Name :
Roll No :
Date of Training :
06-SEP-11 10:28:39 Date :
Affix here a recent
passport size
(3.5 cm x 3.5 cm)
photograph of a
applicant in white
shirt
FORM 1
APPLICATION FORM FOR
CONTINUOUS DISCHARGE CERTIFICATE-CUM-SEAFARE'S IDENTITY
DOCUMENT (CDC) FROM TRAINING INSTITUTES CONDUCTING PRE-SEA
COURSES APPROVED BY DIRECTORATE GENERAL OF SHIPPING
PAGE # 2 OF 2
135 EAST COAST ROAD
KANATHUR 603112
CHENNAI
TAMILNADU
044-27472804
aaditya822@gmail.com
NEELANKARAI
SHRIRAM THIAGARAJAN
FATHER
27/14 SCHOOL VIEW ROAD, FI
R.K. NAGAR, MANDAVELI
CHENNAI
TAMILNADU
600028
044-24643435
Registered Post
House No. :
Village/Post :
Street :
PIN :
District :
State :
Phone :
Email Id :
Near Police Station :
Next of Kin
Next of Kin Name :
Relationship :
House No. : Street :
Village/Post :
District :
State :
PIN :
Phone :