CRW-09-001
SEA STAFF EMPLOYMENT APPLICATION FORM
Personal Information
Photo (C
OMPULSORY)
Name (as per passport) Pawan Kumar
Citizenship India
Date of Birth 27.05.1980
Place of Birth Rewari (Haryana)
Sex Male
Race (Malaysian Only)
Religion Hindu
Marital Status Marrried
Height / Weight 6 Feet
Rank Applied For Master
Expected Daily Rate (if any)
Contact Information
Address | Airport New Delhi
Home Phone +918745864419 Mobil phone +918745800159
Skype -p9810450779 E-mail Mano_kuno@yahoo.co.uk
Passport Information
Date Of Issue 05.07.2011 Passport No J8606230
Date of Expiry 04.07.2021
Place of issue Delhi
Next Of Kin Information
Name of Next of Kin Vinod Kumari Relationship Wife
Home Phone Mobile phone +918745800159
Address RZ-5, Durga Vihar, Ph-2, Dinpur, Najafgarh, New Delhi-110043
Bank Account Information/
1st
Bank Account 2nd
Bank Account
Account Name Pawan Kumar Account Name
Account # 04381060001036 Account #
Account Branch HDFC, Najafgarh Account Branch
Country India Country
Preferred Bank For Salary
Swift Code: HDFC
INBBXXX
EPF & SOSCO Information (Malaysian Citizens/ Malaysian PR)
EPF # SOSCO #
Tax #
Do you have Tax
exemption Letter
Certificates
Cert No
Cert. Class
(I ; II ; III ;
IV)
Date Of
Issue
Date Of
Expiry
Place of Issue
Seaman Card
ID
Seaman Book (Indian) CH-15644 15-11-2011 14-11-2021 Chennai
Seaman Book (Belize) SB-21036 08.04.2013 07.04.2018 Mumbai
Certificate of Competency
(UK)
COC0050562
2nd
Mate
09.02.2010 22.01.2015 UK
Certificate of Competency
(Belize)
CC-12265
Master
01.12.2013 30.11.2018 Mumbai
Basic Safety Training
Medical First Aid BPMA/M/433/2009 05.09.2009 Mumbai
Basic Fire Fighting 2662 02.06.2001 Chennai
Proficiency in Survival
Craft
BPMA/PSCRB/2296/2009 11.12.2009 Mumbai
Personal Social
Responsibility
DG/09/01 07.04.2001 Chennai
GMDSS 120907 22.12.2009 Mumbai
General Operator
Certificate
GG 040085 09.02.2010 08.02.2015 UK
ARPA NavRASO/09/035 11.06.2009 UK
Radar Simulator NavRASO/09/035 11.06.2009 UK
Medicare YAK/MMC/11/08/26/13 08.11.2013 Mumbai
Advance Medical First Aid BPMA/M/433/2009 05.09.2009 Mumbai
Advance Fire Fighting 0020010/02010 09.01.2010 Mumbai
Ship Security Officer SSO 12174 08.06.2012 New Delhi
HUET HUET/5996 11.10.2010 Mumbai
BOSEIT BOSIET/1070 24.09.2011 Mumbai
Helicopter Landing Officer HLO/001 26.09.2010 Mumbai
H2S YAK/H2S/318 27.09.2011 Mumbai
Handling Radio Active 31.07.2013 Lagos Nigeria
PETRONAS Madical KL070 13.12.2012 12.12.2014 Malaysia
Education / Training
Institute Name
Qualification
Obtained
TANKER / CHEMICAL
Certificates
DP Officers / ETO
DP Certification Cert No Date Of Issue Date Of Expiry Place of Issue
Basic SDB/02-266/2009 13.12.2009 Mumbai
Adavance SDBOXV/10-
24/2010/ADV
06.08.2010 Mumbai
Unlimited DPO 18226 04.07.2012 UK
Rank DP Hours DP System Area Of Ops Ops Type
2nd
Mate JDPO 540 C Pos/ Kongsberg Bombay High SB/SU
2nd
Mate JDPO 744 Converteam Srilanka SU/AH
2nd
Mate JDPO 120 Converteam Srilanka SU/AH
2nd
Mate JDPO 1800 Nautronix/NMS L3 Malongo (Angola) AH/SU/TOW
2nd
Mate SDPO 1200 Alstom Cameroun
(Douala)
SU/PSV
Chief Mate SDPO 1300 Bridge Team Malaysia AH/SU/Tow
Chief Mate SDPO 1140 Bridge Team Nigeria AH/SU/Tow
Master SDPO 1530 C Pos/ Kongsberg Nigeria AH/SU/Tow
Master SDPO 900 Bridge Team Nigeria AH/SU/Tow
Master SDPO 720 C Pos/ Kongsberg Nigeria SU/PSV
Master SDPO 605 C Pos/ Kongsberg Nigeria SU/PSV
PREVIOUS SEA SERVICE (COMPULSORY)
VESSEL OWNERS FLAG
VESSEL
TYPE
DP SYSTEM
&
PROPULSION
TYPE
DP1 /
DP2 /
DP3 ENG Type HP / GRT RANK SIGN-ON
SIGN-
OFF
Area of
Oper
ation
s
LENGTH OF
SERVI
CE
Puffin
Arrow
M/s Elite
Marine
BAHMAS
Cargo 27069 Seaman 18.10.02 11.08.03
Pelican
Arrow
M/s Elite
Marine
BAHMAS
Cargo 25846 Seaman 28.04.04 04.06.04
Condor
Arrow
M/s Elite
Marine
BAHMAS
Cargo 25846 Seaman 08.06.04 01.02.05
Pelican
Arrow
M/s Elite
Marine
BAHMAS
Cargo 25846 Seaman 03.04.05 10.12.05
Pelican
Arrow
M/s Elite
Marine
BAHMAS
Cargo 25846 Seaman 14.08.06 27.04.07
Siskin
Arrow
M/s Elite
Marine
BAHMAS
Cargo 25846 Seaman 24.11.07 05.02.08
Sindhu-16 M/s SVS
INDIA
OSV 1321 2nd Mate 20.05.10 15.06.10
Bombay
High 25 Days
CP
Srivastva M/s SVS
INDIA DP-1
(PSV)
C Pos/
Kongsberg
DP1
1310
2nd Mate Jr.
DPO 16.06.10 30.07.10
Bombay
High 45 Days
Sagar
Sandhani M/s SVS
India
Sesmic
Survey
Vsl 2270 2nd Mate 12.10.11 20.11.10
Bombay
High 40 Days
Samudirka-
II M/s SVS
India
OSV 951 2nd Mate 15.12.10 10.05.11
Bombay
High 5 Month
Ozren Tide
M/s
Jublieant
Vanuat
u
DP-
1(AHTS)
Converteam DP1
2538
2nd Mate Jr.
DPO 19.07.11 20.09.11
Srilanka
2 Month
Ozren Tide
M/s
Jublieant
Vanuat
u
DP-
1(AHTS)
Converteam DP1
2538
2nd Mate Jr.
DPO 09.12.11 21.12.11
Srilanka
12 Days
Netherland
Tide
M/s
Jublieant
Vanuat
u
DP-
2(AHTS)
Nautronix/NM
S L3
DP2
2301
2nd Mate Jr.
DPO 21.12.11 21.05.12
Malongo
(Angola) 5 Month
Colee Tide
M/s
Jublieant
Vanuat
u
DP-
1(MSV)
Alstom DP1
997
2nd Mate
Sr. DPO 30.08.12 02.12.2012
Cameroun
(Douala)
3 Month 5
Days
Eagle 1 OTTO SM
Singap
ore
DP-
1(AHTS)
Bridge Team DP1
N/A
1300
Chief officer
Sr.DPO 13.12.2012 27.03.2013
Malaysia 3 Month 15
Days
MDPL
Continantal
One
CS
Offshore
Singap
ore
DP-
2(AHTS)
Bridge Team DP2
Kata piller
2558
Chief officer
Sr.DPO 10.04.13 06.07.13
Nigeria
3 Month
MDPL Asha
Deep
CS
Offshore
Majuro DP-
2(AHTS)
C Pos/
Kongsberg
DP2
Warsalla
2759
Master
Sr.DPO 09.07.13 16.11.13
Nigeria 4 month 13
DAYS
MDPL
Conqueror
CS
Offshore
Singap
ore
DP-
2(AHTS)
Bridge Team DP2
Katapiller
2558
Master Sr.
DPO 11.02.14 11.05.14
Nigeria
3 month
MV Aniaha
CS
Offshore
Lagos DP-
2(MPSV
C Pos/
Kongsberg
DP2
Katapillar
3601
Master
Sr.DPO 18.07.14 16.10.14
Nigeria
3 month
MV Anjali
CS
Offshore
Majuro DP-
2(MPSV
C Pos/
Kongsberg
DP2
Ney Gata
3501
Master
Sr.DPO 09.07.13 16.11.13
Nigeria 2 month 12
days
• All sea service shall be as reflected in the sea-man book.
SUMMARY OF SEATIME (COMPULSORY)
RANK (Offshore Vessels) SEATIME (MONTHS) –
Offshore Vessels
RANK (Main / Merchant
Fleet)
SEATIME (MONTHS) – Main /
Merchant Fleet
2nd
mate JDPO 18 Month Seaman 36 Month
Chief Mate SDPO 7 Month
Master SDPO 16 Month
• All sea service shall be as reflected in the sea-man book.
SUMMARY OF SEATIME (COMPULSORY)
RANK (Offshore Vessels) SEATIME (MONTHS) –
Offshore Vessels
RANK (Main / Merchant
Fleet)
SEATIME (MONTHS) – Main /
Merchant Fleet
2nd
mate JDPO 18 Month Seaman 36 Month
Chief Mate SDPO 7 Month
Master SDPO 16 Month

BUMI ARMADA APPLICATION (New Version)

  • 1.
    CRW-09-001 SEA STAFF EMPLOYMENTAPPLICATION FORM Personal Information Photo (C OMPULSORY) Name (as per passport) Pawan Kumar Citizenship India Date of Birth 27.05.1980 Place of Birth Rewari (Haryana) Sex Male Race (Malaysian Only) Religion Hindu Marital Status Marrried Height / Weight 6 Feet Rank Applied For Master Expected Daily Rate (if any) Contact Information Address | Airport New Delhi Home Phone +918745864419 Mobil phone +918745800159 Skype -p9810450779 E-mail Mano_kuno@yahoo.co.uk Passport Information Date Of Issue 05.07.2011 Passport No J8606230 Date of Expiry 04.07.2021 Place of issue Delhi Next Of Kin Information Name of Next of Kin Vinod Kumari Relationship Wife Home Phone Mobile phone +918745800159 Address RZ-5, Durga Vihar, Ph-2, Dinpur, Najafgarh, New Delhi-110043 Bank Account Information/ 1st Bank Account 2nd Bank Account Account Name Pawan Kumar Account Name Account # 04381060001036 Account # Account Branch HDFC, Najafgarh Account Branch Country India Country Preferred Bank For Salary Swift Code: HDFC INBBXXX EPF & SOSCO Information (Malaysian Citizens/ Malaysian PR) EPF # SOSCO # Tax # Do you have Tax exemption Letter
  • 2.
    Certificates Cert No Cert. Class (I; II ; III ; IV) Date Of Issue Date Of Expiry Place of Issue Seaman Card ID Seaman Book (Indian) CH-15644 15-11-2011 14-11-2021 Chennai Seaman Book (Belize) SB-21036 08.04.2013 07.04.2018 Mumbai Certificate of Competency (UK) COC0050562 2nd Mate 09.02.2010 22.01.2015 UK Certificate of Competency (Belize) CC-12265 Master 01.12.2013 30.11.2018 Mumbai Basic Safety Training Medical First Aid BPMA/M/433/2009 05.09.2009 Mumbai Basic Fire Fighting 2662 02.06.2001 Chennai Proficiency in Survival Craft BPMA/PSCRB/2296/2009 11.12.2009 Mumbai Personal Social Responsibility DG/09/01 07.04.2001 Chennai GMDSS 120907 22.12.2009 Mumbai General Operator Certificate GG 040085 09.02.2010 08.02.2015 UK ARPA NavRASO/09/035 11.06.2009 UK Radar Simulator NavRASO/09/035 11.06.2009 UK Medicare YAK/MMC/11/08/26/13 08.11.2013 Mumbai Advance Medical First Aid BPMA/M/433/2009 05.09.2009 Mumbai Advance Fire Fighting 0020010/02010 09.01.2010 Mumbai Ship Security Officer SSO 12174 08.06.2012 New Delhi HUET HUET/5996 11.10.2010 Mumbai BOSEIT BOSIET/1070 24.09.2011 Mumbai Helicopter Landing Officer HLO/001 26.09.2010 Mumbai H2S YAK/H2S/318 27.09.2011 Mumbai Handling Radio Active 31.07.2013 Lagos Nigeria PETRONAS Madical KL070 13.12.2012 12.12.2014 Malaysia Education / Training Institute Name Qualification Obtained TANKER / CHEMICAL Certificates DP Officers / ETO DP Certification Cert No Date Of Issue Date Of Expiry Place of Issue Basic SDB/02-266/2009 13.12.2009 Mumbai Adavance SDBOXV/10- 24/2010/ADV 06.08.2010 Mumbai Unlimited DPO 18226 04.07.2012 UK Rank DP Hours DP System Area Of Ops Ops Type 2nd Mate JDPO 540 C Pos/ Kongsberg Bombay High SB/SU 2nd Mate JDPO 744 Converteam Srilanka SU/AH 2nd Mate JDPO 120 Converteam Srilanka SU/AH 2nd Mate JDPO 1800 Nautronix/NMS L3 Malongo (Angola) AH/SU/TOW
  • 3.
    2nd Mate SDPO 1200Alstom Cameroun (Douala) SU/PSV Chief Mate SDPO 1300 Bridge Team Malaysia AH/SU/Tow Chief Mate SDPO 1140 Bridge Team Nigeria AH/SU/Tow Master SDPO 1530 C Pos/ Kongsberg Nigeria AH/SU/Tow Master SDPO 900 Bridge Team Nigeria AH/SU/Tow Master SDPO 720 C Pos/ Kongsberg Nigeria SU/PSV Master SDPO 605 C Pos/ Kongsberg Nigeria SU/PSV
  • 4.
    PREVIOUS SEA SERVICE(COMPULSORY) VESSEL OWNERS FLAG VESSEL TYPE DP SYSTEM & PROPULSION TYPE DP1 / DP2 / DP3 ENG Type HP / GRT RANK SIGN-ON SIGN- OFF Area of Oper ation s LENGTH OF SERVI CE Puffin Arrow M/s Elite Marine BAHMAS Cargo 27069 Seaman 18.10.02 11.08.03 Pelican Arrow M/s Elite Marine BAHMAS Cargo 25846 Seaman 28.04.04 04.06.04 Condor Arrow M/s Elite Marine BAHMAS Cargo 25846 Seaman 08.06.04 01.02.05 Pelican Arrow M/s Elite Marine BAHMAS Cargo 25846 Seaman 03.04.05 10.12.05 Pelican Arrow M/s Elite Marine BAHMAS Cargo 25846 Seaman 14.08.06 27.04.07 Siskin Arrow M/s Elite Marine BAHMAS Cargo 25846 Seaman 24.11.07 05.02.08 Sindhu-16 M/s SVS INDIA OSV 1321 2nd Mate 20.05.10 15.06.10 Bombay High 25 Days CP Srivastva M/s SVS INDIA DP-1 (PSV) C Pos/ Kongsberg DP1 1310 2nd Mate Jr. DPO 16.06.10 30.07.10 Bombay High 45 Days Sagar Sandhani M/s SVS India Sesmic Survey Vsl 2270 2nd Mate 12.10.11 20.11.10 Bombay High 40 Days Samudirka- II M/s SVS India OSV 951 2nd Mate 15.12.10 10.05.11 Bombay High 5 Month Ozren Tide M/s Jublieant Vanuat u DP- 1(AHTS) Converteam DP1 2538 2nd Mate Jr. DPO 19.07.11 20.09.11 Srilanka 2 Month Ozren Tide M/s Jublieant Vanuat u DP- 1(AHTS) Converteam DP1 2538 2nd Mate Jr. DPO 09.12.11 21.12.11 Srilanka 12 Days Netherland Tide M/s Jublieant Vanuat u DP- 2(AHTS) Nautronix/NM S L3 DP2 2301 2nd Mate Jr. DPO 21.12.11 21.05.12 Malongo (Angola) 5 Month Colee Tide M/s Jublieant Vanuat u DP- 1(MSV) Alstom DP1 997 2nd Mate Sr. DPO 30.08.12 02.12.2012 Cameroun (Douala) 3 Month 5 Days Eagle 1 OTTO SM Singap ore DP- 1(AHTS) Bridge Team DP1 N/A 1300 Chief officer Sr.DPO 13.12.2012 27.03.2013 Malaysia 3 Month 15 Days MDPL Continantal One CS Offshore Singap ore DP- 2(AHTS) Bridge Team DP2 Kata piller 2558 Chief officer Sr.DPO 10.04.13 06.07.13 Nigeria 3 Month MDPL Asha Deep CS Offshore Majuro DP- 2(AHTS) C Pos/ Kongsberg DP2 Warsalla 2759 Master Sr.DPO 09.07.13 16.11.13 Nigeria 4 month 13 DAYS MDPL Conqueror CS Offshore Singap ore DP- 2(AHTS) Bridge Team DP2 Katapiller 2558 Master Sr. DPO 11.02.14 11.05.14 Nigeria 3 month MV Aniaha CS Offshore Lagos DP- 2(MPSV C Pos/ Kongsberg DP2 Katapillar 3601 Master Sr.DPO 18.07.14 16.10.14 Nigeria 3 month MV Anjali CS Offshore Majuro DP- 2(MPSV C Pos/ Kongsberg DP2 Ney Gata 3501 Master Sr.DPO 09.07.13 16.11.13 Nigeria 2 month 12 days
  • 5.
    • All seaservice shall be as reflected in the sea-man book. SUMMARY OF SEATIME (COMPULSORY) RANK (Offshore Vessels) SEATIME (MONTHS) – Offshore Vessels RANK (Main / Merchant Fleet) SEATIME (MONTHS) – Main / Merchant Fleet 2nd mate JDPO 18 Month Seaman 36 Month Chief Mate SDPO 7 Month Master SDPO 16 Month
  • 6.
    • All seaservice shall be as reflected in the sea-man book. SUMMARY OF SEATIME (COMPULSORY) RANK (Offshore Vessels) SEATIME (MONTHS) – Offshore Vessels RANK (Main / Merchant Fleet) SEATIME (MONTHS) – Main / Merchant Fleet 2nd mate JDPO 18 Month Seaman 36 Month Chief Mate SDPO 7 Month Master SDPO 16 Month