CHINAR SHIPPING & TRADING CO. PVT. LTD.

18, LOHA BHAVAN, CARNAC BUNDER

93, P.D'MELLO ROAD, MASJID (E)
APPLICATION
MUMBAI - 400 009 FORM
TEL NO.: +9122 66350512, 23481261, 23481736
TEL FAX NO.: +9122 66350511
EMAIL: chinarshipping@gmail.com / yahoo.com

Position applied for - l Date of Application

Willing to accept Lower Rank? (Y/N) / /

_________ __________ ___________ Photo

First Name Middle Name Last/Surname

Date of Birth Place of Birth Nationality

Permanent Address Present Address

Pin : Email : Pin :

TEL: TEL:

Next of Kin: Name of Spouse:

Relationship: Name of Dependent Children Relation DateD.
of O.
Birth
B.
Address: 1
2
3
Pin
TEL.NO. TEL.NO.

Document Document No. Date of Issue Place of Issue Date of Expiry

CDC (Ind) / / / /
CDC (Lib) / / / /
CDC(Pan) / / / /
INDOSNo. / / / /
Passport / / / / /

Training Institute (e.g. Rajendra/DMET/NAVY/WORKSHOP Date Com. Date Completion

Apprenticeship with

Highest Competency Certificate Now Held

Authority Comp.Cert. Cert No. Date of Issue Place of Issue Validity
MOT/DTI
Liberian
Panama
Others

Academic Qualification
Degree/Diploma University Year Passed Grade

Please give references of at least two pertsons :

Name Full address Tel.(Office) Tel. (Res.)
STCW & Other Endorsement:
COURSES CERTIFICATE NO. DATE VALIDITY INSTITUTI ON
PSC/PSC&RB/PST
AFF/BFF
MFA/EFA
PSSR
MASTER'S MEDICARE
REVALIDATION/REFRESHER
ROC
GMDSS
GMDSS ENDORSEMENT
BRIDGE TEAM MGMT
S.S.O./ ISPS COURSE
A.R.P.A.
RADAR SIMULATOR
SHIP HANDLING SIMU.
WATCH KEEPING
O.T.F.C.
DCE LVL I
DCE LVL II
WELDING COURSE
YELLOW FEVER
PAN NO.
WHICH UNION / EXPIRY
BOILER SUIT SIZE
SAFETY SHOES SIZE

Sea Experience:
* Enter in descending order (I.e. Last ship first) for at least five years
Company Ship Type GRT Engine BHP Rank From To Y M D

* Last Salary Drawn __________ PM ______________ Last Rank

* Available for joining from _______________________
* I hereby declare that all information furnished above is true to the best of my knowledge and belief.
* I hereby declare that herein mentioned my COC/Licence/All STCW certificates are genuine.
* I further declare that prior to joining you, I will stand released from previous employment.

__________________
Signature

RECEIVED APPLICATION ON :_________________

BY: _______________________