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Elegant Marine Services Private Limited

(Agents of Fleet Management Ltd.)
Our Principal’s Website: www.fleetship.com,
RPSL License No: MUM- 172
DOI: 18/09/2020 DOE: 18/09/2025
Application Form / Personnel Data Update Form
Post applied for: CHIEF OFFICER Willing to accept lower Rank? No Available From: 15/09/2021

(A) PERSONAL PARTICULARS (AS IN PASSPORT)

First Name : ANUJ Middle Name Last Name/Surname: BHATNAGAR

Nationality : INDIAN Date of Birth: 09/03/1989 Place of Birth: KANPUR

Height Weight (In KGS) :62 Smoker / Nonsmoker Yellow Fever Union Membership
(In CMS) Blood Group: B+ Veg. / Non - Veg. DOI DOE BATCH /LOT No.
YES NO
Boiler Suit Size: MED / LARGE / XL / XXL Shoe Size: 6 15/09/10 020
10
Permanent Address: 2 S M I T H S Q U A R E , 1 4 / 1 1 6 Local Address: 2 S M I T H S Q U A R E , 1 4 / 1 1 6
CIVIL LINES CIVIL LINES
City: K A N P U R Tel.: + 9 1 - 6 3 8 9 0 0 0 4 5 6 City: K A N P U R Tel.: 6 3 8 9 0 0 0 4 5 6
Post Code: 2 0 8 0 0 1 Mobile: + 9 1 - 6 3 8 9 0 0 0 4 5 6 Post Code: 2 0 8 0 0 1 Mobile: 6389000456
E-mail: a n u j b h a t n a g a r 0 0 9 @ g m a i l . c o m

Date of Issue Date of Expiry

Document No. Place of Issue
DD / MM/ DD / MM/
YY YY
Passport: Country Z 3062623 12/01/2015 LUCKNOW 11/01/2025
Seaman’s Book (CDC): National MUM179553 23/11/2010 MUMBAI 19/10/2030
Seaman’s Book (CDC): Norwegian
Seaman’s Book (CDC): Liberian
Seaman’s Book (CDC): Panamanian
Seaman’s Book (CDC): Marshall Island MH722006 09/07/2020 08/07/2025
Other (CDC):
Valid US Visa “C1/D” Yes / No Date of Expiry: Passport ECNR: Yes / No
Australian Maritime Crew Visa Yes Date of Expiry: 2 9 / 0 7 / 2 0 2 2

Next of kin: S O N A M S R I V A S T A V A Relationship: W I F E DOB: 0 1 / 0 5 / 1 9 9 0

Alternate next of kin: N E E R A J B H A T N A G A R
(in case of family joining) Relationship: FATHER
Address : 2 SMITH SQUARE, 14/116 CIVIL LINES , KANPUR
Tel.:
....................Family Details....................
Relationship First Name Last Name DOB Passport No. Place Issued Valid until
Spouse SONAM SRIVASTAVA 01/05/1990
Child M / F
Child M / F
* Indicate Type of Valid Visas USA / CANADA / BRAZIL / UK / Others
Anniversary date:
* Please check if visas a n d a l l d o c u m e n t s a r e v a l i d for the tenure on board, plus 6 months.

Applicant Signature: _________________________

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(B) Education / Other Qualifications:
EDUCATIONAL QUALIFICATION
Result Grade (1st, 2nd,
10 + 2 / Degree Institution / University Year of Passing 3rd or A, B, C etc)

10th BETHANY CONVENT SCHOOL 2005 1ST

12th SIR PADAMPAT SINGHANIA ED. 2007 1ST
PRE - SEA TRAINING / APPRENTICESHIP / MARINE ENGINEERING / NAUTICAL DEGREE OR DIPLOMA
Result Grade (1st, 2nd,
Pre - Sea T ra in in g T ra in in g I ns ti tu ti on / C om pa ny Na me From - To 3rd or A, B, C etc)

NAUTICAL DEGREE TOLANI MARITIME INSTITUTE 2007-2011 1ST

CERTIFICATES OF COMPETENCY:
Highest Competency Certificate Held
Date of Passing Examination
Issuing A u t h o r i t y Grade Certificate No. DOI Place Issued Valid until
National ( Country) 1MFG IFO-22481 28/08/2018 DELHI 06/08/2023
Liberian
Panamanian
Marshall I s l a n d 1MFG 642563 01/08/2019 06/08/2023
Norwegian
Hongkong
Others
GMDSS D3537 29/08/2012 DELHI 28/08/2022
GMDSS ( Endorsement) 86388 09/10/2022 DELHI 28/08/2022
LIST OF S.T.C.W. / OTHER COURSES DONE
Courses STCW 1995 STCW 2010 Date of Issue Date of Expiry
1) FPFF / Advanced Fire Fighting 1010036312200522 25/05/2022
2) Elementary / Medical F i r s t A i d / Medicare 11/16679/0371 03/03/2017
3) PSSR 07/25/473 14/09/2007
4) Proficiency in Survival Craft & RB / PST 1010036112200434 25/05/2022
5) STSDSD
6) CTFC / CHEMCO SCT 13239 04/10/2013
7) GTFC / GASCO
8) OTFC / TASCO TA 13052 13/03/2013
9) LCHS (Management / Operational) LCHS(M) 13045 15/03/2013
10) Ship Maneuvering Simulator Course
11) Radar Observer Course / ARPA AR 12182 27/07/2012
12) Radar Simulator Course / RANSCO 25/17104/0305 22/04/2017
13) BTM / BRM 027/2018 05/09/2018
14) Ship Security Officer Course SSO 13022 25/01/2013
15) NIS Familiarization Course
16) C.O.C. Revalidation Course
17) INDOS No. (Mandatory Requirement) 07NL2097
18) STCW 2010 Refresher Courses
19) High Voltage Course
20) Seafarers Identify Documents (SID)
21) Others (Specify)
Dangerous Cargo Certification:
1. Endorsement on NATIONAL Certificate Level Number DOI Place Issued Valid Until
Petroleum MANAGEME DCN02DEL20000 04/12/20 DELHI 03/12/25
Liquefied Gas 5262
Liquid Chemicals MANAGEME DCN02DEL19003 07/05/19 DELHI 06/05/24
2. Other Endorsements 934

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Applicant’s Signature

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(C) SEA SERVICE: (Start from Last Vessel Served)
Flag of Type of Engine make & model & BHP/KW (For DWT (D) From To Total
Name of the Company Name of the Vessel Rank
Vessel Vessel Engineers)
Cargoes Carried (For Deck Officers) GRT (G) dd/mm/yy dd/mm/yy M/D
Non-Fleet Management Vessels
OIL/CHEM
V SHIPS ADVANTAGE PARTY MI ULSD -10PPM , UAN 37067 C/O 30/01/21 08/05/21 3M / 18D
V SHIPS ADVANTAGE SKY MI OIL BRASS CRUDE OIL 156658 2/O 16/08/19 06/09/20 12M / 27D
V SHIPS ADVANTAGE SKY MI OIL BRASS CRUDE OIL 156658 2/O 09/09/18 06/03/19 5M / 28D
OIL/CHEM
V SHIPS ADVANTAGE PRIDE MI FUEL OIL 37311 2/O 18/05/17 16/10/17 5M
OIL/CHEM
V SHIPS STAR I FUEL OIL 37900 3/O 01/08/16 08/01/17 5M / 10D
OIL/CHEM
V SHIPS SKY FUEL OIL 37879 3/O 16/07/15 04/01/16 5M / 22D
V SHIPS ADVANTAGE SKY OIL CRUDE OIL 156658 3/O 26/02/15 05/05/15 2M / 8D
V SHIPS FRONT COMMERCE VLCC CRUDE OIL 299999 3/O 11/08/14 04/11/14 2M / 25D
V SHIPS SAIQ VLCC CRUDE OIL 299999 3/O 19/03/14 22/06/14 3M / 5D
MOL RAYSUT OIL NAPTHA 99995 CDT 01/06/11 11/06/12 12M / 16D

Remarks:

Sea Service with Fleet Management Vessels

Applicant’s Signature

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(E) Experience Matrix of Deck Officer
Please mark ‘Y’ against your rank in the cell, if that experience is applicable to you
S.No. Description M CO 2O 3O Cdt Any Breakdown or incident experience / Remarks

Have you sailed in the following areas ?

1 Indian Ocean Y Y
2 Pacific Ocean
3 North Atlantic Ocean Y Y Y
4 South Atlantic Ocean
5 South China Sea Y Y
6 Australian Waters
7 Mediterranean Sea Y Y Y
8 Black Sea Y Y
9 English Channel / North Sea Y Y Y
10 Singapore Straits Y Y
11 Panama Canal
12 Suez Canal Y Y
13 Kiel Canal Y Y
14 Great Lakes
15
16
17
Chemical / Product Tanker Tank Cleaning experience
1 Cleaned tanks after carriage of veg. oil ?
2 Cleaned tanks for Methanol carriage ?
3 Cleaned tanks MEG or similar cargoes ?
4 Cleaned tanks for Veg Oil carriage ?
5 Cleaned tanks for Jet Fuel ?
6 Changed from dirty to clean products ? Y

Gas Tanker Experience

1 Fully Refrigerated vessel
2 Fully pressurized vessel
3 Partially refrigerated vessel

Oil / Product / Chemical Tanker Experience

1 Inert Gas vessel Y Y Y Y
2 Crude Oil Washing Y Y
3 Inert Gas purging Y Y Y Y
4 Cleaning crude oil tanks for hot work
5 Framo Pumps operation Y Y Y
6 Cargo Heating Y
7 Framo Pump damage
8 Over / Under pressurization of tanks
9 Cargo contamination

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 S.No. Description M CO 2O 3O Cdt Any Breakdown or incident experience/Remarks

Bulk Carrier Experience

1 Hose test for hatch covers
2 Bilge valve testing
3 Ballasting of cargo hold
4 Disposal of cargo residues
5 Draft survey cargo calculations
6 Over / Under pressurization of Holds
7 Cleaned Holds for Grain carriage ?
8 Cleaned Holds for Fertilizer carriage ?

Experience of major overhaul / breakdown

1 Drydock Y Y Y
2 Windlass damage / Loss of Anchor Y
3 Sterring Gear failure

Experience of Special circumstances & Disaster Management

1 Grounding
2 Collision
3 Oil Spill
4 Crank Case Explosion
5 Scavenge Fire
6 Engine Room Fire
7 Cargo Fire
8 Abandon Ship
9 Steering Failure
10 Freezing Weather
11 Heavy weather / TRS
12 Fog / Restricted visibility

Experience in PMS
1 AMOS
2 TM Master

Applicant’s Signature

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 (F) GENERAL:
(1) Have you ever been denied a foreign visa or been deported from any country? Ye s / No
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? Ye s / No
If yes, please attach details
(3) Have you ever signed off a ship due to medical reason within last 3 years? Ye s / No
If yes, please provide following details :

Name of vessel Date of occurrence Place of occurrence

Reason for sign off :

(4) Have you ever been involved in any criminal activity or have pending criminal case? Yes / No
If yes, please provide details.

(5) Have you ever been involved in any navigational incidents in last 24 months? Yes / No
If yes, please provide details.

(6) Are you Currently under Medical Treatment or Taking Medication for Existing conditions? Yes / No
If Yes, please provide details
Comments on above ____________________________________________________________________

(D) Last drawn salary in USD:

8500
(E) References
Please give referees from two recent employers who we may contact for references
Reference 1 Reference 2
Name of Company
Name of Person to contact
Address

Country
Telephone

I Do hereby declare that all information furnished is true to best of my knowledge and belief.

Received acknowledgement of Application form

Date : 31-08-2021 Rank : CHIEF OFFICER Applicant’s Signature

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(H) FOR OFFICE USE ONLY

STAGE II (Checked by : Personnel Officer) Name : Sign

Documentation c h e c k s
a) Copies of all STCW certificates received? Yes / No
b) Copy of all valid Certificates of Competency including Endorsements received ? Yes / No
c) Copy of National or Main Certificate of Competency verification certificate received? Yes / No
d) Copies of Passport including all valid visas received? Yes / No
e) Copies of Seaman’s Book including all pages containing sea service received? Yes / No
f) Copies of Vaccination Book received? Yes / No

Comments regarding non-receipts :

STAGE III ( Assessed By : Marine / Tech. Superintendent / Manager / Deputy General Manager / General Manager)

Name: Sign

Comments:

Regd. Office: Elegant Marine Services Private Limited: 401/A, Elegant Business Park, Off Andheri
Kurla Road, Near Kohinoor Continental Hotel, Andheri (E), Mumbai - 400 059. India
E-mail seacareer@elegantship.com, Tel: (+91 22) 3090 6100 Fax: (+91 22) 3090 6200
e
e

Liaison Offices: GURGAON: Tel. (0124) 4690400 / KOLKATA: Tel: (033) 40566100 /
KOCHI: Tel: (0484) 4063666 / CHENNAI: Tel. (044) 22504730 /
VIZAG: Tel (0891) 2749775 / PATNA: Tel. (0612) 2206788
LUCKNOW: Tel. (0522) 4024685 / CHANDIGARH: Tel. (0172) 4751200
JAIPUR : Tel (141) 4005091

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