APPLICATION FORM FOR ALLOTMENT OF INDOs NO.

Full Name

Shortened Name
with initials Insert F if Female

Permanent Address INDos No.

City State / Provinge Date of Birth

Country Code Postal Code

Phone No. D D M M Y Y Y Y

Passport No. of country code

CDC No. of country code

Photograph

Only for new

Pre Sea Training applicant

Institute Code Certificate No. 25 mm x 25 mm

Workshop Code Certificate No.

Sig of the Applicant

Modular Course
Course Level Institute Code Certificate No. Course Institute Code Certificate No.

First Aid ARPA

Fire Fighting GMDSS

Rescue FRB
LCH Simulator RANSCO

ER Simulator

PSSR

ROC

Indos No. Date of Birth

D D M M Y Y Y Y
Special Ship – Type Certificate
Course Level Institute Code Certificate No. Course Institute Code Certificate No.

Oil Tanker ARPA

Chemical GMDSS

Gas Tanker FRB

Ro-ro Pass

Rating
Date of Issue

Watchkeeping certificate No.

D D M M Y Y Y Y
Certificate of Competency

Grade Certificate No.

D D M M Y Y Y Y D D M M Y Y Y Y
Endorsements
Signatures
Endorsement Type Level Certificate No. Valid Till (DD-MM-YYYY)

Oil Tanker __________________________________

1. Applicant (The above information is true
Chemical to the best of my knowledge and belief

Gas Tanker ___________________________________

2. Designated Officer of MMD / Pre-Sea
Ro-Ro Pass Institute

Passenger Ship ___________________________________

3. Dealing Assistant of LBS College

____________________ _________
4. LBS College Receipt No. Cashier

___________________________________
5. INDos Officer of LBS College

Institute : ____________________ Batch No. : ____________________ Dispatch Date: ____________________ Category : ____________________