e

6
€ [!
9Egl
fs
6-E
NpO
5
o
E
E
.9
@
o
o
&
E g&
n ,- =l

h ;r8lEI
(EE tF
e*
UI!o so
o
E

o
o It
.E r) ; tsi
zva
^3r-E E o /,
.oz EFETEg o
F R I! -o o E z
d
-*I
-1r
nr !i
E; 4i llr f: i!

ffit
lso
t7i- FEefEE E. -:ticc-
EZ
:I! E# I3 3 e E
o f
F:
|=*-r_=
==C
kor=
v=
trfr E P+ E ?H o
t
t E

-EEtf : ii s
F EE
o
.9 E}
t, 'a
po
o
(9
g Io
r, E=

rt
c o 6c
s 6 o
FP E
o

+E E o
ts o (Ef
Fg
o
.9

EE
o
go o 4E; o
E
o
J Eo oo
EoE u EI
IGE EFE
PO va
t:o -d-
E
.9,
15o FgH

qTKT TNIFT{
/ GOVERNMENT OF INDIA
SS-+W of Ttf .nf I Name of Seafarer in fuil d $.rfi. *isl coc No ilUil j 97E6Z
At(rsc -.Kur R_- fttiT qrrE-r 6rqkq / Shippins Master office |!U[AAI_

t
.a-ffi od fr ftfOt r oate or issue st nlt & ftfliu Dare or expiry

u to_2/2019 26tOs/2O2s
I
'J;q'FilU/ Date of blrrh
1?t99t1?2e
\Tfr{il7 pus1onu,,r,
ft,v sex
INDIAN Irl

fu (c) t.ff. {r Heisr,t in cm" 165

erig)anromtao.
coro-or"y..)Hu;,' BLACK / BLACK
1 8N12623
!.i

A I.l,OUND I,lARK ON _

RICHI LEG
 . :.".:,::::
: ..:.'..'':" ..:' qdr
';'
fiH'{tr o.I{err$
qeffi pEnmmiiNirioREss oF SEAFARER

orqiaq scdrr d ft\ *

use PARAI.YA ,ROAD' - ' "'
SPace for official

DELHA - ' '- -.

BADKT

t ret uo {tl anv)

td;qt{. -i. (qR dr{ fr)

g-t'd (qR ot{ d) i E-mail (lr anY)

sL-a-w tF't ero-e s<-+ff

Niii bi xru oF SEAFARER
{H / Name "1II.l[l1!-[9'[lB
qEFq ' ' r'*'-
FATHER
/ Relationshlp

qfll
, PARAIYA
/ Address
D.-E.L.HA
ROAD,BADKI-
dnYn ei t ".

;i. (qR ot{ $) I tet t'to {tt anv)

tffiq

(qR ot{ d) iE-mail (rr any)

{-+d

34