Professional Documents
Culture Documents
1. Personal Data
First Name ZAHEER Middle Name (s) UDDIN Last Name / Surname BABAR
Religion Gender : Male MALE ISLAM: Female 1 Select from : Single Married Divorced Common Law Partner Widowed Separated Rank applied for: 3RD ENGINEER Willing to accept lower rank? Yes No Available From (date): _09_ / 03 / _12_
(DD / MM / YY)
City:KARACHI State: SINDH Nearest Airport :KARACHI Mobile Tel. Contact Method : Collar:14.5
cm
Post Code: Country : PAKISTAN Home Tel:03227041551 Fax: Email Chest: Fax
cm
Post Cap: cm
Sweater size:
SBoilersuit size:
Shoe Size:42
2.
Social Security
Number: Issuing Country Number:
Personal Tax
Issuing Country:
Chapter 14 CRW13 Application Form File Ref: Office File: 11B Revision Number: 03
54000 Tel:
Country:PAKISTAN Mobile:03226700949
Select From : Spouse Partner Child Parent Grand Parent Other Relative (Please Specify)
Family Data:
Relationship Spouse / Partner Child Child Child Child Child
2 2
First Name F F F F F
Last Name
Date of Birth
Passport No.
Issued
Place
Valid Until
M M M M M
USA
Canada
Brazil
Schengen
UK
Other
4. STCW-1978 (amended 1995) Compliant Certificates / Courses and Other Qualifications: (Add separate sheet if data exceeds space available.) Description of Cert / Course (A) Reg I Personal Training Record Reg I/14 Medical Fitness Cert Reg I/9 (B) Reg VI / 1 Basic Safety Training PAKISTAN Personal Survival Techniques PAKISTAN Elementary First Aid Fire Fighting & Fire Prevention Personal Safety & Social Resp. PAKISTAN PAKISTAN PSTC0211 EFA0323 FPFF0199 PSSR-0243 07-02-03 12-02-03 21-02-03 28-02-03 LAHORE LAHORE LAHORE LAHORE IMS LHR IMS IMS LHR IMS LHR Country of Issue Number Date of Issue (DD-MMYY) Date of Expiry (DD-MMYY) Place of Issue Issuing Authority / Body
(C) Reg VI / 2 4 Additional Training Proficiency in Survival Craft & Rescue Boat PAKISTAN Fast Rescue Boats Advanced Fire Fighting Medical First Aid Medical Care (Master / C/O) PAKISTAN PAKISTAN
(D)
Reg II / 1-4, III / 1-4 Officers Certificate of Competency & Ratings Watch-keeping Certificate (including flag state endorsements) C.O.C CLASS IV PAKISTAN 1119 30-06-05 03-02-15 KARACHI PANAMA ENDORSEMENT PANAMA 03-02-15 PANAMA
Enter here actual description given in the Competency Certificate / Watchkeeping Certificate held by you Other mandatory/recommended Certificates / Courses (as applicable) ARPA (Reg II/1 + Solas) Radar Simulator English Language Bridge Team / Resource Mgmnt Hazmat (US 49CFR)
(E)
Select as applicable: Passport Seamans Book Seaman Passport Seafarers Identity Document Registration Book National ID Card PAG-IBIG Housing Insurance Health Insurance Overseas Emp Cert PHL Card Pension Fund Provident Trust Professional Organisation Driving Licence Visa Vaccination Yellow Fever.
Chapter 14 CRW13 Application Form File Ref: Office File: 11B Revision Number: 03
Country of Issue
Number
Place of Issue
(F)
GMDSS Certificates (including flag state endorsements) GMDSS (Main Issuing Authority) GMDSS (Flag State) GMDSS (Flag State) GMDSS (Flag State) GMDSS (Flag State) GMDSS (Flag State)
(G)
Reg V / 1 Special Requirement for Tankers Country Level1:Asst Description Number Level2:Incharge of Issue Endorsement Oil Endorsement Chem I/II Endorsement Chem III Endorsement Gas Tanker Familiarisation Tanker Familiarisation Tanker Familiarisation Special Tanker Safety Special Tanker Safety Special Tanker Safety (Oil) (Gas) (Oil) (Gas) Para 1 Para 1 Para 2 Para 2 (Chemical) Para 1 LEVEL 1 PAKISTAN 1391/M
(Chemical) Para 2
(H) V/2 and V/3 Special requirement for Passenger / Ro-Ro Passenger Vessels Vsl Type Date of Country of Place of Number -Pax / Issue Issue Issue RoRoPax (DD-MMCrowd Management Description Crisis Mgmnt & Human Behaviour Pax Safety, Cargo Safety & Hull Integrity Pax Safety Familiarisation Training Safety Training RoPax
5. Sea Experience : (Start the listing below with the most recent experience)
Company Flag & Vessel Name Type
(1)
GRT
DWT
Main Engine
(2)
BHP
Rank
FESM FESM MSC MSC FLEET FLEET FLEET ENTICE TERRA MARINE
B.M HOPE/PANAMA B.M HOPE/PANAMA MSC LUCIA/FEDIRICA MSC DENNISE MV UNION SPIRIT M.V SERENE STAR M.V SERENE STAR MV ATLANTIC BREEZE M.T TINOS
SULZER 7RND 68 SULZER 7RND 68 SULZER 6RND 90 SULZER 10RND 90 SULZER 7RND 68 MITSUI MAN B&W MITSUI MAN B&W MITSUI MAN B&W MITSUBISHI 8UEC75LS2
24-01-11 25-07-11 26-02-10 28-01-09 02-09-08 26-11-07 25-05-07 12-08-06 01-10-05 24-08-10 04-06-09 27-01-09 29-03-08 24-0907 31-03-07 10-04-06
147537 221000
Chapter 14 CRW13 Application Form File Ref: Office File: 11B Revision Number: 03
(1)
B/C CO CH CH DR DP FS FS
(2)
Bulk Carrier Cellular Chem Carrier Chem Carrier Dredgers Dynamic Fishing Vsl FloatingStorage
FloatgProdStor General Cargo Heavy Lift Vsl Lash Live Stock LNG Carrier Log/Timber LPG Carrier
ML MS NV RIG OS OB O/ OT
Multi-purpose MultiServiceVes Naval Ship OffShore Oil Rig OffShore Supply Ore/Bulk/OilCarr Ore/OilCarrier Other
PA RF R/R PR SA SR SU TU
Chapter 14 CRW13 Application Form File Ref: Office File: 11B Revision Number: 03
(B) Have you undergone any operation in the past? If yes, please provide following details:
Details of operation Date
Yes
No
Present condition
Period of disability
(C) For what illnesses or accidents have you consulted a doctor during the last 12 months?
Details of illness / accident Date Therapy/Treatment
7.
Bank Details:
8.
General
(A) Have you ever been denied a foreign visa? Yes No If yes, state which country and reason (if known) (B) Have you been the subject of a court of enquiry or involved in a maritime accident? If yes, please attach details (C) Give details below of two recent employers who we may contact for references:
Reference 1 Name of Company FESM Name of person to contact CAPTAIN RASHID CHARAG Address
Yes
No
Reference 2
Country Telephone 02134329042 I hereby declare that the above, including Medical History, is true. I further consent to the holding and processing by you and any of your direct or indirect parent or subsidiary or associated or affiliated companies (V Ships) and your or V Ships principals of personal data about me (including where appropriate data concerning racial or ethnic origin, religious beliefs, membership of a trade union, physical or mental health or condition, commission or alleged commission of an offence and the proceedings and the outcome of any proceedings relating thereto) for all purposes related to my application for employment on board vessels managed by V Ships or vessels owned or operated by third parties for whom V Ships is engaged to provide crew. I understand that this data will be stored in your databases in relation to my actual or potential employment by or through V Ships. Further, I confirm that the above may involve the transfer of my personal data within V Ships or to third parties worldwide.
Chapter 14 CRW13 Application Form File Ref: Office File: 11B Revision Number: 03
Chapter 14 CRW13 Application Form File Ref: Office File: 11B Revision Number: 03