This document is an application form submitted by Mhatre Harshverdhan for the position of Chief Engineer. It includes personal details such as name, date of birth, address, family details, qualifications, certifications, sea experience and references. He has over 25 years of experience as an engineer on various types of vessels including tankers and has held Chief Engineer positions previously.

1. Application form for Officers
Position Applied for : CHIEF ENGR.
Are you willing to accept a lower rank? NO NO
Date of Availability: 24 / 11 / 14
PERSONAL DETAILS
1. GENERAL
Name: MHATRE HARSHVERDHAN
Date of Birth:02/09/1967 Place of Birth: VIRAR(MS) Nationality: INDIAN
Permanent address: 343,SIDDHI VINAYAK BUNGLOW, AGASHI (MHATRE WADI ) , VIRAR (west) ,
THANE , MAHARASTRA (INDIA)
Post code: 401301.  No.: 0250-2587764
E-Mail address: mhmhatre@yahoo.com No.: 9881847266
Present address: 343,SIDDHI VINAYAK BUNGLOW, AGASHI (MHATRE WADI ) , VIRAR (west) ,
THANE , MAHARASTRA (INDIA)
Post code: 401301.  No.: 0250-2587764
PHOTO
Civil Status : Married
Height : Cm:167 Weight : Kg:79
Boiler Suit Size :60 Shoe Size :08 Food: Non Veg.
2. FAMILY DETAILS.
Full Name of Next of Kin : M A M A T A Relationship : WIFE
Address of Next of Kin : 343,SIDDHI VINAYAK BUNGLOW, AGASHI (MHATRE WADI ) , VIRAR (west)
,THANE 401301.
Post code: 401301
Contact telephone numbers:  No.: 0250-2587764 No.:
Family
Data
Name
Date of
Anniversary D.O.B PPT. No. D.O.I P.O.I D.O.E ECNR
Wife MAMATA 29/12/1997 02/01/1975 G4721690 17/08/2007 MUMBAI 16/08/2017 NR
Child (M/F) SIMRAN 27/10/1997 K8926507 19/12/2012 THANE 18/12/2022 NR
Child (M/F) ARCHIES 20/01/2000 K8925522 17/12/2012 THANE 16/12/2017 NR
Child (M/F)
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 : Date of Occurrence :
FPD 01 Rev No 0 Date: 01-May-2010 Page 1 of 7

2. (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.
No
(c). Are you addicted to alcohol or drugs of any kind? No
(d).Have You suffered from Following?
Malaria Diabetes Epilepsy Nervous Disability Hepatitis of any kind
No No No No No
(e) Did You ever undergo psychiatric treatment? No
TRAVEL DOCUMENTS & VISA
Passport No: Date of Issue Place of Issue Date of Expiry ECNR Blank Pages
Z 2080185 20/06/2010 THANE 23/06/2020 NR 25
U.S.VISA 31-May-2012 MUMBAI 31-May-2017
MUI Membership No. D.O.E.
99EL0840
Dec 13
Any Other VISA
ACADEMICS & PROFESSIONAL QUALIFICATIONS
1. EDUCATIONAL BACKGROUND.
School / College From To Highest Qualification attained.
(Mumbai university) 83 88 Production engineering
2. PRE SEA TRAINING / APPRENTICE SHIP.
Name of Institute / College From To Grade / Marks Type of Degree
Martek engg. works 92 93 I Junior marine engr.
CERTIFICATIONS & COURSES
1. CDC DETAILS.
Seaman’s Book Number Date of Issue Place of Issue
Date of Expiry
Indian BY100607 21/06/2010 MUMBAI 20/06/2020
Liberian 0799860 17/09/2007 USA 17/09/2012
Panamanian CT 708422 14/08/2006 PANAMA 31/08/2010
Marshall Islands MH-0160956 26/03/2009 VIRGINIA(USA) 25/03/2014
Bahamas
Vanuatu
2. INDOS DETAILS.
INDOS Number
99EL0840
MUI MEMBERSHIP E 034974 DOE 31 DEC 13
3. LICENSES.
License Grade Number Date of Issue Place of Issue
Date of
Expiry
Indian CHIEF ENGR ENG/E/279 09/10/2009 MUMBAI 2015
U.K. CHIEF ENGR COC0037811 15/12/2005 U.K. 9/08/15
Singapore
Malta CHIEF ENGR
96/99M0087N 15 NS
/TTC/000233 23/11/2010 mumbai 9/8/2015
FPD 01 Rev No 0 Date: 01-May-2010 Page 2 of 7

3. 4. DETAILS OF COURSES & CERTIFICATES.
Course Type Number
Date of
Issue
Date of
Expiry
Issued By
Advanced / Basic Fire Fighting 01106007530471 28/04/2001 SCI
Proficiency in Survival Craft / Rescue Boat / PST 2315 30/05/2001 MPT
Elementary / Medical First Aid / Medicare 322/3202 16/10/2003 MMC
Personal Survival & Social Responsibility (PSSR) 0473-98 21/12/1998 HMS
Personal survival technique 9 ( PST) BPMA/PST/0352/2011 8/1/2011 BP
Petroleum Tanker Safety (STPOTO) M0087N15 16/04/1999 MCA
Chemical Tanker Safety (CHEMCO) NS/TTC/000233 14/01/2005 MCA
Gas Tanker Safety (GASCO) M0129H-00933 29/07/2005 MCA
Marine casualty management MCM/060/06 15/6/06 MITSUI
IMS training 1010818120901 18/12/09 ASP
Marine environment awareness training 1060818120901 18/12/09 ASP
Ship security officer course (SSO) 352/032/06 17/06/2006 NMA
Ship security officer course (SSO)
Upgrade
TMI/SSO(U)/2014/25/01 10/3/2014 TOLANI
Helicopter underwater escape
techniques
YAK/HUET/153/2011 17/01/2011
YAK
MARINE
Hydrogen sulphide safety course H2S /0524 31/10/2009 YAK
BASIC HYDRAULIC COURSE 354 9/4/2008 ANGLO
ADVANCED HYDRAULIC COURSE 192 12/4/08 ANGLO
Framo cargo pumping system 102 12/11/2008 ANGLO
Revalidation Course 090065 24/9/09 ANGLO
DP Maintainance course SDB/E/01-147/2013 18/10/13 Biby marine
Yellow Fever 16/09/2005 16/09/2015
5. DANGEROUS CARGO ENDORSEMENTS
Types
Grade / Level
I / II
Number Date of Issue
Place of
Issue
D.O.E
Oil I COC0037811 15/12/2005 U.K. 2015
Chemical I COC0037811 15/12/2005 U.K. 2015
Liquified Gas
FPD 01 Rev No 0 Date: 01-May-2010 Page 3 of 7

4. S.No.
Name of
Owners /
Manager
Name of Vessel Type
DWT
Or
GRT
BHP Engine Type
UMS
Y / N
FPD 01 Rev No 0 Date: 01-May-2010 Page 4 of 7
Rank From To
Total
MM/DD
Reason
for
S/Off
1. Tag offshore Tag -10 Dp 2/AHTS 2430
4500
X2
WARTSILA 9L32 Y c/e 25/5/14 17/7/14 1m 22d EOC
2. Tag offshore Tag -10 Dp 2/AHTS 2430
4500
X2
WARTSILA 9L32 Y c/e 17/11/13 20/1/14 2m 4d EOC
3. ANDROMEDA M.T. TRUE ULCC 61341 14444
Man b& w
Y C/E 25/2/2013 12/5/2013 3 M 17D EOC
4. ANDROMEDA M.T. TRUE ULCC 61341 14444
Man b& w
Y C/E 29/6/2012 03/10/2013 3 M 5D EOC
5. Tag offshore Tag -9 Dp1 1922 4582 GE Y c/e 10/12/11 11/1/12 1m 14d EOC
6. Tag offshore Nand krishna Dp1/psv 1313 6128 CATERPILLAR N c/e 4/10/11 10/11/11 1m8d EOC
7. Tag offshore Tag - 4 Dp1/psv 1922 6140 GE Y c/e 10/6/11 8/8/11 2m EOC
8. ANDROMEDA M.T. SPIKE ULCC 61341 14444
Man b& w
Y C/E 29/9/2010 5/1/2011 3 M 5D EOC
9. ASP
OCEANIC
COBALT
Chemical
Tanker
8505 8600
Man b& w
4440kw
Y C/E 19/12/2009 05/05/2010 4M 16D
End of
contract
10. OMCI
FAIRCHEM
UNICORN
Chemical
Tanker
11580 8250 MAN B&W Y C/E 10/03/2009 31/07/2009 4M 20D
End of
contract
11. GENOA IONIAN TRADER
Chemical
Tanker
24310 9660 Sulzer 5rta58 Y C/E 22/11/2008 24/01/2009 2M 3D EOC
12. GENOA IONIAN TRADER
Chemical
Tanker
24310 9660 Sulzer 5RTA58 Y C/E 27/05/2008 15/08/2008 2M 19D EOC
13 GENOA
MERLIN
CHAMPION
Chemical
Tanker
21963 11100
Sulzer 6RLB66
Y C/E 24/09/2007 18/03/2008 5M 25D EOC
14. GENOA
CHAMPION
ADRIATIC
Chemical
Tanker
22572 11100 Sulzer 6RLA66 Y 2/E 22/03/2007 06/08/2007 4M 15D EOC
15. MITSUI NAVIX AZALEA VLCC 146745 28000 MAN B&W Y 2/E 27/06/2006 03/11/2006 4M 6D EOC
16. GENOA
CHAMPION
PIONEER
TANKER 22572 9220 B&W 5l60 MC Y 2/E 03/12/2005 03/04/2006 4M 00D EOC
17.
WORLD
TANKER
KOLOSSI VLCC 137728 23200
Mitsubishi
7UEC75LSII
Y 2/E 22/02/2004 04/08/2004 5M 18D EOC

5. 18.
WORLD
TANKER
KOLOSSI VLCC 137728 23200
Mitsubishi
7UEC75LSII
Y 2/E 13/02/2003 14/08/2003 6M 01D EOC
19. WORLD WIDE NILE VLCC 153407 31290
Sulzer
Y 2/E 01/12/2003 20/01/2004 1M 20D
20. HMS ASTYPALEA TANKER 16977 11200
Sulzer
7RND76
N 2/E 22/03/2002 04/10/2002 6M 12D EOC
21 HMS ROSETTA TANKER 19351 12500 B & W 6k74 EF N 2/E 11/06/2001 18/12/2001 6M 06D EOC
22 HMS MICHEL IULIANO TANKER 12500 10099 Sulzer 4RTA76 N 2/E 28/10/2000 13/03/2001 4M 15D EOC
23. HMS Liano TANKER 17381 12600 B& W 6K74EF N 3/E 28-aug-99 29-mar-00 7.1 EOC
24 HMS Yellow star TANKER 23721 14000 Sulzer 7 RND 76 N 3/E 7-apr-98 9-oct-98 6.1 EOC
25 HMS White star TANKER 18092 12000 Sulzer 7 RND 68 N 3/E 14-feb-97 11-aug-97 5.9 EOC
26 HMS Nevada TANKER 29465 13100 B&W 7167FC N 3/E 10-apr-96 23-oct-96 6.5 EOC
27 HMS Obo victory TANKER 32607 16000 B&W 6180GFC N 3/E 25-jun-95 6 -jan-96 6.5 EOC
28 HMS Atlantic sea TANKER 22126 14000
Sulzer 7 RND 76
N 3/E 13-Aug-94 13-feb-95 6.1 EOC
29 HMS Green star TANKER 15027 11550
Sulzer 7 RND 68
N 4/E 28-oct-93 13-jun-94 7.6 EOC
30 HMS Blue star TANKER 15027 11550 Sulzer 7 RND 68 N J/E 11-sep-92 09-0ct-93 12.27 EOC
FPD 01 Rev No 0 Date: 01-May-2010 Page 5 of 7

6. FPD 01 Rev No 0 Date: 01-May-2010 Page 6 of 7

7. MISCELLANEOUS
1. DECK OFFICERS.
Bulk: Type of cargo carried
GRAIN
Product: Type of cargo carried VEGETABLE OIL
Chemical: Type of cargo carried
BENZENE,NITRATE,RBD OLIEN,PALM OILSTEARIN,KERNEL OIL,SOYABEAN
OIL,MOLASES
Tanker: Type of pumps FRAMO/COP
2. ENGINEERS.
Automation. (Type) NORCONTROL, HONEYWELL,KONSBERG
Cranes. (Type) SAMSUNG, MITSUBHISHI
Grabs. (Type)
3. ELECTRICAL OFFICERS.
Automation. (Type) NA
NOR Control System. (Type) NA
Cranes Hydraulics, Electro Hydraulics. (Type) NA
PLC. (Type) NA
4. GENERAL TRADING AREA OF VESSELS
ALL OVER THE WORLD
5. OIL MAJOR INSPECTIONS.
CDI Yes
Port State Control. (Please Specify) USCG/AMSA/EU
Others. (Please Specify) SHELL / TOTAL
6. DRY DOCKING EXPERIENCE.
YES/ FOUR TIMES
REFERENCES
Name of company GENOA ASP
Reference Person CAPT-VADHAVKAR MR. DINESH RAMPAL
Address : 402/LAXMI MALL 301/ SOLITIRE PARK
LAXMI IND. ESTATE ANDHERI (w) ANDHERI (EAST)
 No.
No.
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.
Date___24/11/14________ Rank_ C/E Signature of Seaman
___________________
This Is Computer Generated CV, Doesn’t Require Signature
FPD 01 Rev No 0 Date: 01-May-2010 Page 7 of 7