Orient Ship Management & Manning Pvt. Ltd.

Licence No. RPSL-MUM-019 Validity: 15.02.2021 Photo

 601, G l ob al Ch amb e rs, 276, R.P.S . Fl ats,
O f f- New L i n k Road , And h er i (W ), Sh ei k h Sar ai , Ph ase - 1,
Mu mbai - 400 053. In di a Nea r A.P.J . S chool ,
Te l : 26736 459 (6 L i n es) New Del h i – 110017 , Ind i a
Emai l : mann in g@osmm.com Te l : 26017 457 / 260160 65
c rew i n g @osmm.com Fax: 2601 745 6
Web si te : www.osmm.com Emai l : d el h i @osmm.com
FO R ENG I NEE RS , EL E CTRI CAL O F F I CE R & E LE CT RO T EC HCH NI CAL
RAT IN G
Date of Availability Post Applied for Height Weight
SUR NAME: FIRST NAME: MDDLE NAME:
Nationality: Date of Birth: Place of Birth:
Blood Group: Shoe Size: Boiler Suit Size:
DE TAILS O F CE RTIFICATE S OF CO MP E T E NC Y
Date of Date of Certificate
Date Passed Rank Issued by
Issue Expiry Number
INDIAN C.O.C.
UK / OTHER C.O.C.
PANAMA C.O.C.

Date of Date of Place of EMMIGR CLR

Document Number
Issue Expiry Issue Yes / No
PASSPORT
U.S.A. VISA
CDC (INDIAN)
CDC (PANAMA)
CDC (NORWAY)
CDC (OTHER)
Yellow Fever
Number of blank pages in the passport
RE CO RD OF E DUCAT IO NAL Q UA L IFICATIO N
Name of Institute Percentage of Marks Year Passed Course Duration
SCHOOL FINAL
COLLEGE
PRE – SEA
INDOS NUMBER
RE CO RD OF PRE VIO US SE RVICES
Shipping Date
DWT / Main Eng. &
Company Name of Ship Flag Type BHP Rank From to
GRT Type
(Full Name)

DETAILS OF S.T.C.W. & VALUE ADDED COURSES / CERTIFICATES

Place of Date of Date of Issued Certificate
Issue Issue Expiry By Number
 1. Proficiency in Survival Craft and Rescue Boats
Other than Fast Rescue Boats (PSCRB)
2. Advance Fire – Fighting (AFF)
3. Medical First aid (MFA)
4. Personal Safety & Social Responsibilities (PSSR)
5. Specialised Tanker Safety Course (Oil) (TASCO) /
Tanker Familiarization Course (OTFC)
6. Specialised Chemical Tanker Course (CHEMCO) /
Tanker Familiarization Course (CTFC)
7. Specialised LPG Tanker Course (GASCO) /
Tanker Familiarization Course (GTFC)
8. DCE (OIL) Operation/Management (Strike out which is not applicable)
9. DCE (CHEM) Operation/Management (Strike out which is not
applicable)
10 DCE(LPG) Operation / Management (Strike out which is not applicable)
11. Ship Security Officer (SSO) / Security Training with
Designated Security Duties
12. C.O.C. Revalidation Certificates
13. Certificate of Proficiency – For Electro Technical Rating
14 Engine Room Team Management (ERM)
15. E/R Simulator Course – Operation / Management
16. Oil Pollution Act – OPA 90
17. USA – HAZMAT
18. Risk Assessment & Risk Management
19. Incident Investigation & Root Cause Analysis
20. TMSA familiarization
21. Vessel Inspection Preparation – Operation / Management
22. Passenger Ship Familiarisation
23. Vessel Resource Management (VRM)
24. Internal Auditors Course
Local Address in Mumbai & Contact No. Permanent Address, Contact No. (with STD Code) & Email

Relation- Passport Date of Date of Issuing USA VISA

Next of Kin DOB E.C.N.R.
ship Number Issue Expiry Authority Expiry Date

Correct and detail information about Next of Kin is very important from legality point of view. Next of Kin includes dependent
parents, spouse and children.
ACKNOWLEDGEMENT: (1) COPY RECEIVED (2) ALL INFORMATIONS FURNISHED BY ME ARE TRUE & MY CERTIFICATES ARE
GENUINE .
Date: Rank Signature
SEAMAN (REG.No) M.U.I MEMBERSHIP No
NOTE NO.1 : THE APPLICATION FORM IS FREE OF COST
NOTE NO.2: NO PROCESSING FEES OR RECRUITMENT CHARGES ARE LIABLE.
NOTE NO.3: EMPLOYMENT SUBJECT TO CONFIRMING THE STATUTORY REQUIREMENTS & OWNER’S APPROVAL.
NOTE NO.4: INFORMATIONS IN THIS FORM SHALL BE KEPT PRIVATE & CONFIDENTIAL.
NOTE NO:5: THIS APPLICATION WILL BE ACCEPTED AND PROCESSED WITHOUT ANY BIAS BASED ON APPLICANTS CASTE, CREED, SEX.
RELIGION, POLITICAL OPINION, NATIONALITY OR SOCIAL ORIGIN

OSMM-APLCN (09/17)