POSITION Position Applied for :THIRD ENGINEER Are you willing to accept a lower rank?NOYES / NO Date of Availability: 01/01/2017
PERSONAL DETAILS 1. GENERAL
Date of Birth:12/12/1979Place of Birth: GONDIANationality:INDIAN
Post code:400607 No.:02266732640
Present address:SAME AS ABOVE
Post code: No.: Civil Status :Single / Married / Separated / Divorced / Widowed.---MARRIED Height :172CmWeight :65Kg Boiler Suit Size LARGEShoe Size :8 2. FAMILY DETAILS. Full Name of Next of Kin : YUWRAJ N. BANSODKARRelationship :FATHER Address of Next of Kin :SAME AS ABOVE Post code: Contact telephone numbers: No.:022-66732640No.:+91-9892594872/7039306727/9930775872
Family DataNameDate of AnniversaryD.O.BPPT. No.D.O.IP.O.ID.O.EECNR WIFEPOOJA S. BANSODKAR30/MAY/201328/09/1986 FATHERY. N. BANSODKAR12/07/1948 MOTHERUSHA Y. BANSODKAR31/07/1953 SISTERNILISHA Y. BANSODKAR11/01/1982 BROTHEROJAS P. GONDANE09/02/2003
3. MEDICAL HISTORY (a).Have you ever signed off from a ship due to Medical reasons,(If Yes give details)No Name of the Vessel : NADate of Occurrence :NA Brief description of Illness / Injury / Accident :NA (b). Did you suffer or Are you Presently suffering from any disease likely to render you unfit for service at sea or likely to endanger the Health of others on board.Yes / No: NO (c). Are you addicted to alcohol or drugs of any kind?Yes / No: NO (d).Have You suffered from Following? MalariaDiabetesEpilepsyNervous DisabilityHepatitis of any kind Yes / No: NOYes / No:NOYes / No: NOYes / No:NOYes / No:NO (e) Did You ever undergo psychiatric treatment?Yes / No:NO
TRAVEL DOCUMENTS & VISA Passport No: Date of IssuePlace of IssueDate of ExpiryECNRBlank Pages P131506109/05/2016THANE08/05/2026YESYES U.S.VISAMUI Membership No.D.O.E.
Any Other VISA
ACADEMICS & PROFESSIONAL QUALIFICATIONS 1. EDUCATIONAL BACKGROUND. School / CollegeFromToHighest Qualification attained. K.J. SOMAIYA COE, MUMBAI UNIVERSITY AUG-1999 NOV-2005B.E. MECH.
2. PRESEA TRAINING / APPRENTICE SHIP. Name of Institute / CollegeFromToGrade / MarksType of Degree M.E.R.I. MUMBAI 01/01/2007 31/12/2007FIRST CLASS/ DIST. G.M.E.
CERTIFICATIONS & COURSES 1. CDC DETAILS. Seaman’s BookNumberDate of IssuePlace of IssueDate of Expiry
IndianMUM 151549 28/01/2008MUMBAI 27/01/2018 Liberian Panamanian Marshall Islands Bahamas Vanuatu IOM Bermuda / Maltese Others 2. INDOS DETAILS. INDOS Number
07EL0547
28/MAY/2007
MUMBAI NA 3. LICENSES. LicenseGradeNumberDate of IssuePlace of IssueDate of Expiry IndianCLASS IV 95Z-1141128/01/2015MUMBAI12/12/2019 U.K. Singapore Australian Liberian Panamanian Vanuatu I O M Bermuda 4. DETAILS OF COURSES & CERTIFICATES. Course TypeNumberDate of IssueDate of ExpiryIssued By FPFFFPFF/047415/12/2007 -M.E.R.I. MUMBAI Proficiency in Survival Craft Rescue Boat 09004516/01/2009 -L.B.S NAUTICAL COLLEGE Medical First Aid SMI/MFA/1425/200924/01/2009 -SNS MARITIME INST. Personal Survival & Social Responsibility (PSSR)PSSR/047415/11/2007 -M.E.R.I. MUMBAI Engine room Simulator(OP. LEVEL)07022907/07/2007 -L.B.S NAUTICAL COLLEGE Oil Tanker Familiarisation (OTFC)SMI/OTF/3809/200801/02/2008 -SNS MARITIME INST. TASCO13000121/02/2013 -L.B.S NAUTICAL COLLEGE Engine Room Simulator(MGMT. LEVEL)13002822/03/2013 -L.B.S NAUTICAL COLLEGE Yellow Fever2241505/01/2008 04/01/2018MUMBAI STSDSDMA/DSD/34/79319/11/2013 - MARINERS ACADEMY Refresher and Updating Training CourseRUPE-A/720/2014-1513/12/2014 -OERC ACADEMY Engine room Simulator(MGMT. LEVEL)13002822/03/2013 -IMU LBS CoAMS&R Augmentation of fire fightingSMI/AUG/FPFF/379/201513/02/2015 -SNS MARITIME INST. Advanced Fire Fighting(Refresher)RAFF/12/38/15/1420/12/2014 19/12/2019YAK MGMT. & MEC SSOBPMA/SSO/2647/201417/12/2014 -B.P. MARINE ACADEMY PSTPST/047425/12/2007 -M.E.R.I. MUMBAI PSCRB(Refresher)PSCRB®/15/00103/012015-NAMAC MUMBAI GASCOBPMA/GASCO/21/201502/02/2015 -B.P. MAR. ACADEMY Advanced Fire Fighting441814/02/2009 -T.S. CHANAKYA ELEMENTARY FIRST AIDEFA/047416/11/2007 -M.E.R.I. MUMBAI
5. DANGEROUS CARGO ENDORSEMENTS TypesGrade / Level I / IINumberDate of IssuePlace of IssueD.O.E OILIIM/O/2/E/13/2420222/11/2013MUMBAI21/11/2018 CHEMICALIM/C/1/E/08/43277407/02/2008MUMBAI17/01/2013 GASIM/G/1/E/15/2734318/02/2015MUMBAI17/02/2020
PREVIOUS SEA SERVICE ( Date commencing from FIRST vessel ) S.No.Name of Owners / ManagerName of VesselBuilt YearTypeDWT Or GRTBHPEngine TypeUMS Y / NRankFromToTotal MM/DDReason for S/Off 1.S.C.I. LTD.M.T. PALANIMALAI1994CHEMICAL TANKER210356310MAN B&W, 2STROKE 6S60MCN5EO20/02/200820/11/2008 9M/1DCONTRACT COMPLETE 2.S.C.I. LTD.M.V. DAKSHINESHWAR1984 BULK 2873910800MAN B&W, 2STROKE 6LMC N3EO17/08/201001/06/2011 9M/13DCONTRACT COMPLETE 3. S.C.I. LTD.M.T. DESH SAMMAN 2010 OIL TANKER 64397 15820MAN B&W, 2STROKE 6S60 MCE Y 4EO 09/11/2011 21/06/2012 7M/12DCONTRACT COMPLETE 4.S.C.I. LTD.M.T. SWARNA GANGA 2010 OIL TANKER 42845 15500MAN B&W, 2STROKE 7S60 MC Y 3EO04/12/201318/02/2014 2M/14DCOMPASSIONATE SIGN OFF 5.S.I.S. LTDM.T. ORCHIDS1986OIL TANKER176128042.9SULZER WARTSILA RTA 58N3EO26/03/201401/11/20147M/6DCONTRACT COMPLETE 6.S.I.S. LTDM.T. ORCHIDS1986OIL TANKER176128042.9SULZER WARTSILA RTA 58N3EO03/03/201502/06/20152M/30DMUTUAL AGREEMENT 7.S.I.S. LTDM.T. PRUDENT1991PRODUCT/OIL TANKER2822311150MAN B&W 6S50 MCN3EO15/08/201505/02/20165M/21DMUTUAL AGREEMENT 8.S.I.S. LTDM.T. PRUDENT1991PRODUCT/OIL TANKER2822311150MAN B&W 6S50 MCN3EO07/09/201610/10/20161M/3DMUTUAL AGREEMENT 9.S.I.S. LTDM.T. ORCHIDS1986OIL TANKER176128042.9SULZER WARTSILA RTA58N3EO14/10/201621/11/20161M/7DCONTRACT COMPLETE
SALARY DRAWN: 2.0 LAC INR /MONTH EXPECTED SALARY: 3.5 LAC INR/MONTH MISCELLANEOUS 1. DECK OFFICERS. Bulk: Type of cargo carried Product: Type of cargo carried Chemical: Type of cargo carried Tanker: Type of pumps 2. ENGINEERS. Automation. (Type)UMS/NON UMS Cranes. (Type) Grabs. (Type) 3. ELECTRICAL OFFICERS. Automation. (Type) NOR Control System. (Type) Cranes Hydraulics, Electro Hydraulics. (Type) PLC. (Type) 4. GENERAL TRADING AREA OF VESSELS FOREIGN GOING( NEW ZEALAND,AUSTRALIA,MORROCCO, EGYPT,CHINA, SINGAPORE,ETC) AND COASTAL(INDIAN COASTLINE) 5. OIL MAJOR INSPECTIONS. CDI Yes / No PortState Control. (Please Specify)YES, AMSA. Others. (Please Specify)SHELL VETTING(twice) 6. DRY DOCKING EXPERIENCE.
REFERENCES Name of companyS.I.S. LTD Reference PersonSUNIL U. GONDANE (CHIEF OPERATIONS OFFICER) Address :S.I.S. LTD, 7TH FLOOR, TIMES SQUARE, SAKI NAKA, ANDHERI, MUMBAI 400069
No.022-29203268 No.09820234226
DECLARATION I hereby affirm that all this information provided by me in this application is true and correct to the best of my knowledge and belief; further, that no Certificate of competency or License issued to me has ever been Revoked or Suspended. I also certify that my medical history contained above is True and any false statement or undisclosed material information about past illness or injury will disqualify me from any employment benefits and claims.
Date01/01/2017 Rank_3EO ____ Signature of Seaman __SD/-