Annexure 1
Post Applied For :
Personal Details :
Name :
Father's Name :
Date of Birth :				Nationality :
Height :				Weight :
Identification Mark :				Sex :
Permanent Address :
Contact No. :
e-mail :
Documents	No.	Place of Issue	Date of Issue	Valid upto
Indian Passport
Indian CDC
INDOS
Educational Qualifications :
Examination	Year of Passing		Marks obtained		Division
Technical Qualification :
Course	Institute	Govt Body	Academic Session		Marks Obtained		Division
Pre-Sea Training : ( Apprenticeship )
Nature of Training	Training Institute		From - To
Certificate of Competency :
Examination	Conducted by	Passed in	Certificate No.
List of STCW' 95 Courses :
Name of Course	Certificate No.		Date of Issue	Place of Issue
Personal safety &
social responsibility
Elemency First Aid
Fire Prevention &
Fire Fighting
Personal Survival
Techniques
Oil Tanker
Familiation
Date :		Place :				Signature :