Chennai:

2nd Floor Sai Building, Old 62/1 New 79/1, Lloyds Road, Royapettah, Chennai 600014
Tel: +91 44 4684999 Fax: +91 44 28475288 crewing@nautilusshipping.com

RPSL NUMBER:RPSL/CHN/012

VALID UNTIL 16.12.2018

Application Form
App No:
Rank Applied For :

Chief Engineer

Availability Date :

Nearest Airport
First NameGanesa Murthy
Date of Birth :

Middle Name

Last Nam

7/13/1979 Place of Birth /State: Chennai/Tamil Nadu

Present Rank

Addl. Chief EngVessel (Present):

Marital Status

Married

Zone

CRUDE TANKER

North

Nationali
Vessel (Preferre
Experien

Permanent Address : No:9, Jagannathan Colony, Foxen StPresent Address :

Perambur, Chennai-600011
City
Pincode
Phone :
Mobile:
Email :

Chennai

State

Tamil Nadu

City

600011 Pincode
9962837310 Phone :
Mobile :
Email:

ganeshmarine@rediffmail.com

skype id

REF : ANY MARINER SAILED WITH YOU

NAME

RANK

MOBILE

1)
2)
Documents
Certificate of Competency (national)
Certificate of Competency (others)
Passport
CDC (National)
CDC (others)
US Visa C1/D

Grade

Number

CLASS 1 F95W-7913
J 4048894
CH-100860

Date of
Place of Issue
Issue
7/17/2014 Kolkata
3/1/2011 Chennai
9/30/2003 Chennai
3/17/2011 Chennai

Page 1

Yellow Fever

9/4/2013 Kolkata

Full Name of Next of KiKeerthi

Address of Next of Kin:

Relationsh

No:9, Jagannathan colony, Foxen street, Perambur, Chennai-11

Height in cms:

180

Boiler Suit Size :

XXL

PAN CARD NUMBER

Phon
Weight in Kgs:

Shoe Size :
AHSPG6224F

Page 2

11

INDOS NUMBER

94

Family
Data

Date of
Birth

Name

Wife

Keerthi

Child M/F

Arjhun/Male

Place of
Birth

Passport Place of
No.
Issue

6-Jul-84 Bangalore
23-Jul-11 Bangalore

Child M/F
Child M/F
Child M/F

Details of Courses & Certificates

Number

Date of
Issue

Date of
Expiry

Issued By

Advanced Fire Fighting / AFF

R-AFF/B45/14

5/1/2013 30-Apr-18 HIMT

Personal Survival Techniques

RPST/B46/14

4/30/2013 29-Apr-18 HIMT

Elementary First Aid

Fire Prevention & Fire Fighting

R-FPFF/B45/14

5/1/2013 30-Apr-18 HIMT

Proficiency in Survival Craft & Rescue

Boat / PSCRB

RPSCRB/B46/14

4/30/2013 29-Apr-18 HIMT

Medical First Aid/Medicare

MFA/B302/01

7/17/2004

HIMT

RSSO/B17/RM/B93/06

29-Nov-13

HIMT

13225- MANAGEMENT

4/21/2014

1193/2009

3/14/2009

Personal Safety & Social Responsibility

(PSSR)
Radar Observer / ARPA
Radar Simulator / RANSCO
Engine Room Simulator (MGNT LEVEL)
SSO
STSTD
Bridge Team Management
Ship Handling Simulator
GMDSS
GMDSS COC
DCE PETROLEUM(Mgmt / Oper)

### KOLKATA-MMD

DCE CHEMICAL(Mgmt / Oper)

DCE GAS (Mgmt / Oper)
OIL TANKER FAMILN (OTF)
TASCO
CHEMICAL TANKER FAMILN (CTF)
CHEMCO
LIQUID GAS TANKER FAMILN (LGTF)
GASCO
Page 3

NAMAC, MUMBAI

LCHS
ECDIS
Upgradation of COC (Deck/Eng) courses
Revalidation course for Deck/Engineer Of

SCHOOL

NAME OF INSTITUTE
KALIGI RANGANATHAM MONTFIRD
MATRIC HIGH SCHOOL

COLLEGE

JNNCE, SHIMOGA

PRESEA

SBV, CHENNAI

From

To

PERCENT

1996

1997

71% FIRST CLASS

1997

2001

73%

6/24/1905 6/25/1905 A

Page 4

Type of Degre

FIRST CLASS WITH

DISCTINCTION

Shore Employemnt
From

To

Rank / Nature Of Work

Employer Details

Last Two Employers' Name , PIC, and Contact No.

1
2

Computer Based PMS Experienced AMOS & SMMS

New Construction Experience
Dry Docking Experience

2/E(TURKEY), 3/E(DUBAI) & 5/E(SRILANKA)

Medical History (Please give details if you have suffered from discease/Previously operated )

1. Have you ever been denied a foreign Visa

If Yes, state which country and reason (if known)

2. Have you been the subject of a court of enquiry or involved in a Maritime Accident
If Yes please attach details

Declaration

I hereby affirm that all information provided by me in this application is true, factual and to the b
my knowledge and belief and I have not withheld any information I fully abide by company's rule
terms of employment

Date :__17-DEC-15_____________________

Page 5

Signature:__________________________

FORM NS 01

Photo

1/5/2016

Arunachalam
Indian
Vessel (PreferreFPSO
>24 Months

State

MOBILE

EMAIL ID

Place of Issue Expiry Date

Kolkata

12/31/2016

Chennai
Chennai

2/28/2021
9/29/2023

Chennai

3/14/2016
Page 6

Kolkata

9/14/2023

Wife

Phone : 0
BMI
99EL5959

Page 7

Date
of
Issue

Date of
Expiry

Issued By
HIMT
HIMT

HIMT
HIMT
HIMT

HIMT

KOLKATA-MMD

NAMAC, MUMBAI

Page 8

Type of Degree
FIRST CLASS
FIRST CLASS WITH
DISCTINCTION

Page 9

Employer Details

KA)

viously operated )

No

No

e, factual and to the best of

de by company's rules and

________________________

Page 10

Previous Sea Service (Data Commencing from Last Vessel)

Sl. Name of Owners
Year
Name of Vessel FLAG
No
/ Manager
Built

Type

GRT

TEU

Engine
Type

KW

UMS
Rank
Y/N

From

To

Month
s

Synergy

MT.Nave Lucida

Panama 2005 OIL TANK 28799

Man B&W

9480 Y

Add C/E 02/07/15 07/11/15

4.3

Synergy

MT.Nanyang Star Singapo 2013 OIL TANK 56326

Man B&W

12350 N

Add C/E 10/11/14 27/02/15

3.6

BWFM

MT.BW Orinoco

Singapo 2007 OIL TANK 43797

Man B&W

11016 Y

2/E

18/06/14 25/09/14

3.3

Synergy

MT.Nanyang Star Singapo 2013 OIL TANK 56326

Man B&W

12350 N

2/E

07/12/13 14/03/14

3.2

Synergy

Singapo 2008 OIL TANK 62241

Sulzer

14000 N

2/E

23/09/12 16/04/13

6.8

Synergy

MT.Isis
MV.APL
Zeebrugge

Singapo 2012 Containe 86679

Man B&W

82810 N

2/E

04/06/12 16/06/12

0.4

Synergy

MT.Isis

Panama 2008 OIL TANK 62241

Sulzer

14000 N

2/E

10/10/11 08/02/12

4.0

Synergy

MT. APL Ireland

Singapo 2004 Containe 66462

Man B&W

57200 N

2/E

19/06/11 04/08/11

1.5

Synergy

MT.APL California Singapo 2010 Containe 71787

Man B&W

62920 N

2/E

20/03/11 30/05/11

2.4

MV.APL Florida
MT.Amba
Bhargavi
MT.Amba
Bhavanee

Singapo 2010 Containe 71787

Man B&W

62920 N

2/E

05/08/10 24/01/11

5.7

Indian

2008 OIL TANK 57243

Man B&W

13557 Y

Add 2/E 14/04/09 12/11/09

7.1

Indian

2006 OIL TANK 58136

Man B&W

13530 Y

3/E

15/12/08 17/02/09

2.1

Man B&W

23309 Y

4/E

27/09/07 12/02/08

4.6

14 Univan

MT.Pacific Garnet Panama 1995 OIL TANK154651

MT. Shinyo
Navigator
Singapo 1996 OIL TANK156852

Man B&W

24501 Y

4/E

14/12/06 09/08/07

7.9

15 Univan

MT.Bab Aden

Panama 1982 OIL TANK

3742

Mitsubishi

2466 N

5/E

06/03/05 11/10/05

7.3

16 Gati

MV.Gati-1

Indian

3552

Mitsubishi

1915 N

5/E

12/12/03 13/07/04

7.1

10 Synergy
11 Varun
12 Varun
13 Univan

1983 GC

Page 4

Reason for S/Off

contract
completion
contract
completion
contract
completion
contract
completion
contract
completion
company's
request
contract
completion
company's
request
contract
completion
contract
completion
contract
completion
not completing
NRE days
contract
completion
contract
completion
contract
completion
contract
completion

Page 4