FORM 29

(See Rule 72)

GOVERNMENT OF INDIA
MINISTRY OF SURFACE TRANSPORT
DIRECTORATE GENERAL OF SHIPPING
Application for Examination and Assessment for certificates under Merchant
Shipping (Standards of Training, Certification and Watch-keeping for Seafarers)

Application No. : SB/MMD(DL)/2022/10009118 Received Date :21/06/2022

A. Grade of Examination : Master of a Foreign Going Ship

Place of Examination : MMD DELHI

1. Full Name : SHIVPUJAN SINGH

(Block letters)

2. Permanent Address : House No 43kahlon Garden City Sec 12bvrindavan Colony 226029, Lucknow,Uttar
Pradesh,India

SB/MMD(DL)/2022/10009118
3. Present Address : H No 43kahlon Garden City Sec 12vrindavan Colony,Lucknow,226029 Uttar
Pradesh,India
4. Telephone Number : 8127677012
(with STD Code)
5. Nationality : INDIAN
(Proof to be produced)
6. Passport Number : Z5869970
7. Date and Place of Issue : 08/06/2020 At LUCKNOW
8. Continuous Discharge : MUM 191599
Certificate (C.D.C)
Number
9. Date and Place of Issue : 13/09/2011 At MUMBAI
10. Date of Birth : 10/06/1992
(Proof to be produced)
11.Place of Birth : TONK
12.Personal Identification : CUT MARK ABOVE LEFT EYE
marks
13. INDos No : 11NL1001
14. Email Id : shivpujan7@gmail.com
Note : Any Person who makes, causes to be made or assists in making any false representation for the purpose of obtaining for himself /

B. DETAILS OF SCHOLASTIC EDUCATION :

(Separate sheets must be attached)
1.Scholastic Education Level : 10+2 (HSC/Intermediate/equivalent)
2.Principal Subjects : Pcm Eng
3. Year of Passing : 2010
4. School/College/ Board : KENDRIYAVIDYALAYA CBSE
5. Address of the Institution : KV NO2 CHANDIMANDIR CANTT PANCHKULA HARYANA

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C. DETAILS OF PRE-SEA TRAINING / MARINE ENGINEERING WORKSHOP :
(Separate sheet must be attached )

1. Training Institute : IMU, Navi Mumbai Campus

2. Address of the Institution : Indian Maritime University, Navi-Mumbai Campus ,T. S. Chanakya, Palm Beach Road
Opposite Karave village, Nerul,400 706 director.navimumbai@imu.ac.in,022-27702343,022-
27700398
3. Attended From : 09/08/2010 To 09/08/2011
4. Result : PASS
5. Courses Attended : Diploma In Nautical Science

D1. DETAILS OF SEA-GOING SERVICE (FOR DECK DEPARTMENT PERSONNEL) :

Port of Trade: Period

Gross
Name of Registry/ NCV/ FG/
Type Tonnage Rank From To Remarks
Ship Official Coastal
Number Months
Days
Chemical Tanker
MT TRF KOBE 12225 6856 FG Chief Officer 07/08/2021 29/01/2022 5 24

Chemical Tanker
MT FG ROTTERDAM 11520 FG Chief Officer 06/09/2020 06/04/2021 7 1

MT CHEMICAL Chemical Tanker

8253 FG Second Officer 25/08/2019 20/02/2020 5 27
PROVIDER
MT CHEMICAL Chemical Tanker
8259 VALETTA FG Second Officer 13/06/2018 20/12/2018 6 8
MASTER

SB/MMD(DL)/2022/10009118
MT CELSIUS
MANHATTAN
Chemical Tanker
11615 MAJURO FG
Watch Keeping
Deck Officer
OINW or Third
officer
05/06/2017 20/12/2017 6 16

Watch Keeping
MT CHEMICAL Chemical Tanker Deck Officer
9155 SINGAPOR FG 11/05/2016 08/12/2016 6 29
CHALLENGER OINW or Third
E
officer
Watch Keeping
Chemical Tanker HONGKON Deck Officer
MT ATLANTIC DIANA 29266 FG 11/09/2015 20/03/2016 6 10
G OINW or Third
officer
Special Category : 1.Nature
HONGKON of watch keeping - Assistant
MV AQUA VISION Bulk Carrier 94815 FG Deck Cadet 08/05/2013 29/03/2014 10 23
G Officer of Navigational
Watch,
Special Category : 1.Nature
Chemical Tanker HONGKON of watch keeping - Assistant
MT JBU OPAL 11561 FG Deck Cadet 01/05/2012 10/02/2013 9 11
G Officer of Navigational
Watch,

E-1 REPORT ON STRUCTURED ON-BOARD TRAINING :

Phase No Date Of Name of Master Details Of Certificate Of Competancy

SSTPOC 28/03/2014 TS CHANAKYA TSC/DNS/003/140

E-2 REPORT OF DESIGNATED COMPANY TRAINING OFFICER :

Signature :

Name : Certificate No. :

E-3 REPORT OF HEAD OF ASSESSMENT CENTRE :

Signature :

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 Name : Official Stamp :

F. REPORT OF ASSESSMENT CENTRE :

POST-SEA APPROVED EDUCATION AND TRAINING AT APPROVED INSTITUTION LEVEL
2M(Operational)/1M&M(Management)

Function /Part Institution From To Remarks

Applied Research International 14-JUN-2014 14-OCT-2014

PHASE1 Fosma Maritime Institute & Research Organisation 15-DEC-2016 14-MAR-2017

PHASE2 HSNA Maritime Education And Research 15-JAN-2018 14-APR-2018

School of Higher Academic And Professional Education

03-MAY-2021 14-JUN-2021
(SHAPE)

F-2 REMARKS OF HEAD OF ASSESSMENT CENTRE :

ELIGIBILTY FOR OPERATIONAL/MANAGEMENT LEVEL(Phase I & II)

SB/MMD(DL)/2022/10009118
ELIGIBILITY FOR WRITTEN FUNCTION
ELIGIBILTY FOR ORALS FUNCTION
I/II/III/ASM
I/II/III/ASM

* Online application may be provisionally approved subject to verification of Originals during Orals

Signature :

Name : Official Stamp :

G. PARTICULARS OF STCW CONVENTIONS MODULAR COURSES (POST-SEA) :

STCW Reg. / Period

Sr. Validity
Courses STCW Code Cert. No. Approved Institution
No.
No From To
Fosma Maritime Institute &
1 Ship Manoeuvering Simulator 3050182241220044 18-JUL-2022 22-JUL-2022
Research Organisation (Kol)

Centre for Maritime Education And

2 Refresher Training for Medical Care 1010036422220135 07-MAY-2022 07-MAY-2022 06-MAY-2027
Training

Centre for Maritime Education And

3 Refresher Training for Proficiency in FPFF 1010031531955011 29-JUL-2019 29-JUL-2019 28-JUL-2024
Training

Simulator- Liquid Cargo Handling - Oil -

4 30301408619127 SEI Educational Trust 29-APR-2019 03-MAY-2019
Management level
Applied Research International -
5 Radar and Navigation Simulator 1110220251946411 School of Higher Academic & 07-JAN-2019 12-JAN-2019
Professional Education - I
imerpat/medicare/254- Institute of Marine Education And
6 Medical Care A-VI/4-2 15-MAY-2017 26-MAY-2017 25-MAY-2022
2017/007 Research

Advanced Training for Chemical Tanker CMETL/STPCTO/029/11 Centre for Maritime Education And
7 11-MAY-2015 21-MAY-2015
Cargo Operations 9 Training

Advanced Training for Oil Tanker Cargo CMETL/STPOTO/208/14Centre for Maritime Education And
8 27-APR-2015 07-MAY-2015
Operations 07 Training

SMI/PSSR/17473/2015
9 Personal Safety & Social Responsibilities A-VI/1-4 SNS Maritime Training Institute 13-APR-2015 15-APR-2015

10 Refresher Training for Medical First Aid SMI/RMFA/1200/2015 SNS Maritime Training Institute 11-APR-2015 11-APR-2015 11-APR-2020

TSR/RFRH/PSCR&RB/0
11 Refresher Training for Proficiency in PST TS Rahaman 07-APR-2015 07-APR-2015 06-APR-2020
02616

Refresher Training For Proficiency In PSCRB TSR/RFRH/PSC&RB/00

12 TS Rahaman 07-APR-2015 07-APR-2015 06-APR-2020
2616

Refresher Training for Advanced Training in TSR/RFRH/AFF/002253

13 TS Rahaman 06-APR-2015 06-APR-2015 05-APR-2020
Fire Fighting

Generated on : 02/11/2022 10.17 AM Page 3 of 12

 14 Ship Security Officer BPMA/SSO/255/2015 BP Marine Academy 09-FEB-2015 11-FEB-2015

Electronic Chart Display and Information Fleet Management Training

15 103/14-15 02-FEB-2015 06-FEB-2015
Systems Institute

16 General Operator`s Certificate for GMDSS D-4478 Oceans XV Educational Trust 05-MAY-2014 17-MAY-2014 20-MAY-2024

17 Automatic Radar Plotting Aids A-II/1 AR 14064 Applied Research International 28-APR-2014 02-MAY-2014

18 Radar Observer Simulator A-II/1 RO14069 Applied Research International 14-APR-2014 25-APR-2014

Centre for Maritime Education And

19 Medical First Aid A-VI/4-1 CMET/MFA/401/1847 01-APR-2013 04-APR-2013
Training

Centre for Maritime Education And

20 Advanced Training in Fire Fighting A-VI/3 CMET/AFF/371/3747 25-MAR-2013 30-MAR-2013
Training

Proficiency In Survival Craft and Rescue Centre for Maritime Education And
21 A-VI/2-1 CMET/PSCRB/80/1177 18-MAR-2013 22-MAR-2013
Boats Training

Familiarization Training Programme For LNG

22 BPMA/LGT/690/2011 BP Marine Academy 19-SEP-2011 23-SEP-2011
Tanker Operation

BPMA/CTFC/719/2011
23 Tanker Familiarization- Chemical BP Marine Academy 12-SEP-2011 16-SEP-2011

24 Tanker Familiarization- Oil BPMA/TFC/694/2011 BP Marine Academy 05-SEP-2011 09-SEP-2011

25 Fire Prevention & Fire Fighting A-VI/1-2 538/FPFF/11-12 IMU, Navi Mumbai Campus 11-APR-2011 13-APR-2011

26 Personal Survival Techniques A-VI/1-1 481/PST/10-11 IMU, Navi Mumbai Campus 07-MAR-2011 09-MAR-2011

27 Elementary First Aid A-VI/1-3 483/EFA/10-11 IMU, Navi Mumbai Campus 03-MAR-2011 05-MAR-2011

H. PREVIOUS CERTIFICATE ( Issued in India or elsewhere, If none state so) :

If any time suspended or cancelled, state

SB/MMD(DL)/2022/10009118
Place & date of Examination
Number Certificate
Class /Grade
Details Examination Issue Date
Court of Authority
Date Cause
First Mate of a Foreign Going Ship
1 IFO 23251 MUMBAI 04-JUL-2019
Second Mate of a Foreign Going
2 IF-32463
Ship
MUMBAI 11-JUN-2015

I. DECLARATION TO BE MADE BY THE CANDIDATE :

I hereby declare that the particulars contained in the form are correct and true to the best of my knowledge and belief
and that the papers enumerated and sent with this form are true and genuine documents given and signed by the person
whose name appears on them. I further declare that Section D contains a true and correct account of my sea-going service
without exception and I make this declaration conscientiously believing the

SHIVPUJAN SINGH The above declaration was signed in my presence.

Signature of the candidate Examiner of Masters and Mates

Mercantile Marine Department.........................District

J. REQUEST FOR ALLOTMENT OF SEATS FOR EXAMINATION :

Sign of
Sign of
Fees Paid Written Papers Orals Candidate
Examiner
Applied
Month Grade
for
Referance No CARGO CARGO/
Amount NAV1 NAV2 NAV3 NAV4
/ ASM
SOF1 SOF2 NAV
ASM
SOF
& Date

WSBI12280675
MMD
JUL-2022 MASTER 12000 44 21/06/2022 Y
DELHI

WSBI12955879
MMD AUG-2022
MASTER 12000 83 23/07/2022 Y
DELHI

YSBI142475706
MMD OCT-2022
MASTER 12000 0 21/09/2022 N
DELHI

K 1. Sight Test :Date of Examination : _________________Result _____________Signature of Examiner

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K 2. RESULT OF EXAMINATION :( for official purpose only) :

Name of Examiner
No. Written Papers Orals Signal
of O : Oral , W :Written
Atte Month Grade
mpts CARGO/ CARGO/
NAV1 NAV2 NAV3 NAV4 SOF1 SOF2 NAV SOF
ASM ASM

1 JUL-2022 MASTER PASS

O-Capt.S.K.Das
AUG-2022
2 MASTER FAIL

OCT-2022
3 MASTER

Note :
Second Mate (FG) / NWKO-NCV : NAV 1: Terrestrial and coastal Navigation, NAV 2: Celestial Navigation, NAV 3: Meteorology, NAV 4: Bridge Watch Keeping and Emergencies.

First Mate (FG / NCV ): Phase I: NAV 1:Terrestrial and coastal Navigation. NAV 2: Meteorology, SOF 1: Ship Safety, Damage Control and Management of Personnel, SOF 2: Naval
Architecture Paper I.

First Mate (FG / NCV ) Phase II: NAV 1: Navigation AIds Including compasses, NAV 2: Bridge Watch Keeping . Ship Handling and Emergencies , NAV 3: Engineering Knowledge ,
Instruments and Control Systems , SOF 1: Naval Architecture Paper II, SOF 2: Marine Legislatoin .

SB/MMD(DL)/2022/10009118
L. REPORT OF EXAMINATION CENTRE
1. I hereby certify that Shivpujan Singh has satisfactory produced testimonials and proof of sea-going
service/watch keeping service/approved workshop training as required for the grade.

2. The candidate complies with the examination of the Merchant Shipping Standards (Standards of Training
Certification and Watch-keeping for Seafarers) Rules, 1998 for the grade of Master of a Foreign Going Ship

3. The candidate has passed his examinations for the functions as under :

Function
Phase Level
Written Written Examiner Oral Oral Examiner

M. FOR THE CHIEF EXAMINER OF MASTERS AND MASTES

1. I hereby certify that Shivpujan Singh born at Tonk on 10.06.1992 has satisfactory produced his testimonials and proof
of Sea-going Service/Watch Keeping Service.

2. The candidate complies with the Merchant Shipping (Standards of Training Certification and Watch-keeping for
Seafarers) Rules, 1998 for the grade of Master of a Foreign Going Ship

3. The candidate has passed the examination of the functions as under :

Phase Level Function Sign. of Examiner with Remarks

Written Oral

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 The candidate meets the requirements be eligible to be issued the Certificate of Competency as ...............................................
provisional certificate issued No.................................................................... on....................................................................

Examiner of Masters and Mates

Mercantile Marine Department

N. FINAL ASSESSMENT PRIOR CERTIFICATION

Medical Fitness

Pre-Sea Training Complied

Structured on Board Training N/A

Sea-Service Requirement Complied

Written Examination (Assessment) Yes

Oral Assessment Yes

Modular Courses Complied

Eligibility Yes

Certificate for Competency Master of a Foreign Going Ship as recommended by Mercantile Marine Department may be issued.

Assessor at Directorate General of Shipping for Masters and Mates.

Remarks_____________________________________________________________________

SB/MMD(DL)/2022/10009118 Chief Examiner

(Masters and Mates)

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A. Grade of Examination : Master of a Foreign Going Ship

Place of Examination : MMD DELHI

1. Full Name : SHIVPUJAN SINGH

(Block letters)

2. Permanent Address : House No 43kahlon Garden City Sec 12bvrindavan Colony 226029, Lucknow,Uttar
Pradesh,India

3. Present Address : H No 43kahlon Garden City Sec 12vrindavan Colony,Lucknow,226029 Uttar

Pradesh,India
4. Telephone Number : 8127677012
(with STD Code)
5. Nationality : INDIAN
(Proof to be produced)
6. Passport Number : Z5869970
7. Date and Place of Issue : 08/06/2020 At LUCKNOW
8. Continuous Discharge : MUM 191599
Certificate (C.D.C)
Number
9. Date and Place of Issue : 13/09/2011 At MUMBAI
10. Date of Birth : 10/06/1992
(Proof to be produced)

SB/MMD(DL)/2022/10009118
11.Place of Birth
12.Personal Identification
marks
: TONK
: CUT MARK ABOVE LEFT EYE

13. INDos No : 11NL1001

14. Email Id : shivpujan7@gmail.com
Note : Any Person who makes, causes to be made or assists in making any false representation for the purpose of obtaining for himself /

B. DETAILS OF SCHOLASTIC EDUCATION :

(Separate sheets must be attached)
1.Scholastic Education Level : 10+2 (HSC/Intermediate/equivalent)
2.Principal Subjects : Pcm Eng
3. Year of Passing : 2010
4. School/College/ Board : KENDRIYAVIDYALAYA CBSE
5. Address of the Institution : KV NO2 CHANDIMANDIR CANTT PANCHKULA HARYANA
C. DETAILS OF PRE-SEA TRAINING / MARINE ENGINEERING WORKSHOP :
(Separate sheet must be attached )

1. Training Institute : IMU, Navi Mumbai Campus

2. Address of the Institution
3. Attended From
4. Result
5. Courses Attended
: Indian Maritime University, Navi-Mumbai Campus ,T. S. Chanakya, Palm Beach Road
Opposite Karave village, Nerul,400 706 director.navimumbai@imu.ac.in,022-27702343,022-
27700398
: 09/08/2010 To 09/08/2011
: PASS
: Diploma In Nautical Science

D1. DETAILS OF SEA-GOING SERVICE (FOR DECK DEPARTMENT PERSONNEL) :

Generated on : 02/11/2022 10.17 AM Page 7 of 12

 Port of Trade: Period
Gross
Name of Registry/ NCV/ FG/
Type Tonnage Rank From To Remarks
Ship Official Coastal
Number Months
Days
Chemical Tanker
MT TRF KOBE 12225 6856 FG Chief Officer 07/08/2021 29/01/2022 5 24

Chemical Tanker
MT FG ROTTERDAM 11520 FG Chief Officer 06/09/2020 06/04/2021 7 1

MT CHEMICAL Chemical Tanker

8253 FG Second Officer 25/08/2019 20/02/2020 5 27
PROVIDER
MT CHEMICAL Chemical Tanker
8259 VALETTA FG Second Officer 13/06/2018 20/12/2018 6 8
MASTER
Watch Keeping
MT CELSIUS Chemical Tanker Deck Officer
11615 MAJURO FG 05/06/2017 20/12/2017 6 16
MANHATTAN OINW or Third
officer
Watch Keeping
MT CHEMICAL Chemical Tanker Deck Officer
9155 SINGAPOR FG 11/05/2016 08/12/2016 6 29
CHALLENGER OINW or Third
E
officer
Watch Keeping
Chemical Tanker HONGKON Deck Officer
MT ATLANTIC DIANA 29266 FG 11/09/2015 20/03/2016 6 10
G OINW or Third
officer
Special Category : 1.Nature
HONGKON of watch keeping - Assistant
MV AQUA VISION Bulk Carrier 94815 FG Deck Cadet 08/05/2013 29/03/2014 10 23
G Officer of Navigational
Watch,
Special Category : 1.Nature
Chemical Tanker HONGKON of watch keeping - Assistant
MT JBU OPAL 11561 FG Deck Cadet 01/05/2012 10/02/2013 9 11
G Officer of Navigational
Watch,

SB/MMD(DL)/2022/10009118
E-1 REPORT ON STRUCTURED ON-BOARD TRAINING :

Phase No Date Of Name of Master Details Of Certificate Of Competancy

SSTPOC 28/03/2014 TS CHANAKYA TSC/DNS/003/140

E-2 REPORT OF DESIGNATED COMPANY TRAINING OFFICER :

Signature :

Name : Certificate No. :

E-3 REPORT OF HEAD OF ASSESSMENT CENTRE :

Signature :

Name : Official Stamp :

F. REPORT OF ASSESSMENT CENTRE :

POST-SEA APPROVED EDUCATION AND TRAINING AT APPROVED INSTITUTION LEVEL
2M(Operational)/1M&M(Management)

Function /Part Institution From To Remarks

Applied Research International 14-JUN-2014 14-OCT-2014

PHASE1 Fosma Maritime Institute & Research Organisation 15-DEC-2016 14-MAR-2017

PHASE2 HSNA Maritime Education And Research 15-JAN-2018 14-APR-2018

School of Higher Academic And Professional Education

03-MAY-2021 14-JUN-2021
(SHAPE)

Generated on : 02/11/2022 10.17 AM Page 8 of 12

F-2 REMARKS OF HEAD OF ASSESSMENT CENTRE :

ELIGIBILTY FOR OPERATIONAL/MANAGEMENT LEVEL(Phase I & II)

ELIGIBILITY FOR WRITTEN FUNCTION I/II/III/ASM
ELIGIBILTY FOR ORALS FUNCTION I/II/III/ASM

* Online application may be provisionally approved subject to verification of Originals during Orals

Signature :

Name : Official Stamp :

G. PARTICULARS OF STCW CONVENTIONS MODULAR COURSES (POST-SEA) :

STCW Reg. / Period

Sr. Validity
Courses STCW Code Cert. No. Approved Institution
No.
No From To
Fosma Maritime Institute &
1 Ship Manoeuvering Simulator 3050182241220044 18-JUL-2022 22-JUL-2022
Research Organisation (Kol)

Centre for Maritime Education And

2 Refresher Training for Medical Care 1010036422220135 07-MAY-2022 07-MAY-2022 06-MAY-2027
Training

Centre for Maritime Education And

3 Refresher Training for Proficiency in FPFF 1010031531955011 29-JUL-2019 29-JUL-2019 28-JUL-2024
Training

SB/MMD(DL)/2022/10009118
Simulator- Liquid Cargo Handling - Oil -
4 30301408619127 SEI Educational Trust 29-APR-2019 03-MAY-2019
Management level
Applied Research International -
5 Radar and Navigation Simulator 1110220251946411 School of Higher Academic & 07-JAN-2019 12-JAN-2019
Professional Education - I
imerpat/medicare/254- Institute of Marine Education And
6 Medical Care A-VI/4-2 15-MAY-2017 26-MAY-2017 25-MAY-2022
2017/007 Research

Advanced Training for Chemical Tanker CMETL/STPCTO/029/11 Centre for Maritime Education And
7 11-MAY-2015 21-MAY-2015
Cargo Operations 9 Training

Advanced Training for Oil Tanker Cargo CMETL/STPOTO/208/14Centre for Maritime Education And
8 27-APR-2015 07-MAY-2015
Operations 07 Training

SMI/PSSR/17473/2015
9 Personal Safety & Social Responsibilities A-VI/1-4 SNS Maritime Training Institute 13-APR-2015 15-APR-2015

10 Refresher Training for Medical First Aid SMI/RMFA/1200/2015 SNS Maritime Training Institute 11-APR-2015 11-APR-2015 11-APR-2020

TSR/RFRH/PSCR&RB/0
11 Refresher Training for Proficiency in PST TS Rahaman 07-APR-2015 07-APR-2015 06-APR-2020
02616

Refresher Training For Proficiency In PSCRB TSR/RFRH/PSC&RB/00

12 TS Rahaman 07-APR-2015 07-APR-2015 06-APR-2020
2616

Refresher Training for Advanced Training in TSR/RFRH/AFF/002253

13 TS Rahaman 06-APR-2015 06-APR-2015 05-APR-2020
Fire Fighting

14 Ship Security Officer BPMA/SSO/255/2015 BP Marine Academy 09-FEB-2015 11-FEB-2015

Electronic Chart Display and Information Fleet Management Training

15 103/14-15 02-FEB-2015 06-FEB-2015
Systems Institute

16 General Operator`s Certificate for GMDSS D-4478 Oceans XV Educational Trust 05-MAY-2014 17-MAY-2014 20-MAY-2024

17 Automatic Radar Plotting Aids A-II/1 AR 14064 Applied Research International 28-APR-2014 02-MAY-2014

18 Radar Observer Simulator A-II/1 RO14069 Applied Research International 14-APR-2014 25-APR-2014

Centre for Maritime Education And

19 Medical First Aid A-VI/4-1 CMET/MFA/401/1847 01-APR-2013 04-APR-2013
Training

Centre for Maritime Education And

20 Advanced Training in Fire Fighting A-VI/3 CMET/AFF/371/3747 25-MAR-2013 30-MAR-2013
Training

Proficiency In Survival Craft and Rescue Centre for Maritime Education And
21 A-VI/2-1 CMET/PSCRB/80/1177 18-MAR-2013 22-MAR-2013
Boats Training

Familiarization Training Programme For LNG

22 BPMA/LGT/690/2011 BP Marine Academy 19-SEP-2011 23-SEP-2011
Tanker Operation

BPMA/CTFC/719/2011
23 Tanker Familiarization- Chemical BP Marine Academy 12-SEP-2011 16-SEP-2011

24 Tanker Familiarization- Oil BPMA/TFC/694/2011 BP Marine Academy 05-SEP-2011 09-SEP-2011

25 Fire Prevention & Fire Fighting A-VI/1-2 538/FPFF/11-12 IMU, Navi Mumbai Campus 11-APR-2011 13-APR-2011

26 Personal Survival Techniques A-VI/1-1 481/PST/10-11 IMU, Navi Mumbai Campus 07-MAR-2011 09-MAR-2011

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 27 Elementary First Aid A-VI/1-3 483/EFA/10-11 IMU, Navi Mumbai Campus 03-MAR-2011 05-MAR-2011

H. PREVIOUS CERTIFICATE ( Issued in India or elsewhere, If none state so) :

If any time suspended or cancelled, state
Place & date of Examination
Number Certificate
Class /Grade
Details Examination Issue Date
Court of Authority
Date Cause
First Mate of a Foreign Going Ship
1 IFO 23251 MUMBAI 04-JUL-2019
Second Mate of a Foreign Going
2 IF-32463
Ship
MUMBAI 11-JUN-2015

I. DECLARATION TO BE MADE BY THE CANDIDATE :

I hereby declare that the particulars contained in the form are correct and true to the best of my knowledge and belief
and that the papers enumerated and sent with this form are true and genuine documents given and signed by the person
whose name appears on them. I further declare that Section D contains a true and correct account of my sea-going service
without exception and I make this declaration conscientiously believing the

The above declaration was signed in my presence.

Signature of the candidate Examiner of Masters and Mates

Mercantile Marine Department.........................District

SB/MMD(DL)/2022/10009118
J. REQUEST FOR ALLOTMENT OF SEATS FOR EXAMINATION :

Sign of
Sign of
Fees Paid Written Papers Orals Candidate
Examiner
Applied
Month Grade
for
Referance No CARGO CARGO/
Amount NAV1 NAV2 NAV3 NAV4
/ ASM
SOF1 SOF2 NAV
ASM
SOF
& Date

WSBI12280675
MMD
JUL-2022 MASTER 12000 44 21/06/2022 Y
DELHI

WSBI12955879
MMD AUG-2022
MASTER 12000 83 23/07/2022 Y
DELHI

YSBI142475706
MMD OCT-2022
MASTER 12000 0 21/09/2022 N
DELHI

K 1. Sight Test :Date of Examination : _________________Result _____________Signature of Examiner

K 2. RESULT OF EXAMINATION :( for official purpose only) :

Name of Examiner
No. Written Papers Orals Signal
of O : Oral , W :Written
Atte Month Grade
mpts CARGO/ CARGO/
NAV1 NAV2 NAV3 NAV4 SOF1 SOF2 NAV SOF
ASM ASM

1 JUL-2022 MASTER PASS

O-Capt.S.K.Das
AUG-2022
2 MASTER FAIL

OCT-2022
3 MASTER

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Note :
Second Mate (FG) / NWKO-NCV : NAV 1: Terrestrial and coastal Navigation, NAV 2: Celestial Navigation, NAV 3: Meteorology, NAV 4: Bridge Watch Keeping and Emergencies.

First Mate (FG / NCV ): Phase I: NAV 1:Terrestrial and coastal Navigation. NAV 2: Meteorology, SOF 1: Ship Safety, Damage Control and Management of Personnel, SOF 2: Naval
Architecture Paper I.

First Mate (FG / NCV ) Phase II: NAV 1: Navigation AIds Including compasses, NAV 2: Bridge Watch Keeping . Ship Handling and Emergencies , NAV 3: Engineering Knowledge ,
Instruments and Control Systems , SOF 1: Naval Architecture Paper II, SOF 2: Marine Legislatoin .

L. REPORT OF EXAMINATION CENTRE

1. I hereby certify that Shivpujan Singh has satisfactory produced testimonials and proof of sea-going
service/watch keeping service/approved workshop training as required for the grade.

2. The candidate complies with the examination of the Merchant Shipping Standards (Standards of Training
Certification and Watch-keeping for Seafarers) Rules, 1998 for the grade of Master of a Foreign Going Ship

3. The candidate has passed his examinations for the functions as under :

Function
Phase Level
Written Written Examiner Oral Oral Examiner

SB/MMD(DL)/2022/10009118
M. FOR THE CHIEF EXAMINER OF MASTERS AND MASTES

1. I hereby certify that Shivpujan Singh born at Tonk on 10.06.1992 has satisfactory produced his testimonials and proof
of Sea-going Service/Watch Keeping Service.

2. The candidate complies with the Merchant Shipping (Standards of Training Certification and Watch-keeping for
Seafarers) Rules, 1998 for the grade of Master of a Foreign Going Ship

3. The candidate has passed the examination of the functions as under :

Phase Level Function Sign. of Examiner with Remarks

Written Oral

The candidate meets the requirements be eligible to be issued the Certificate of Competency as ...............................................
provisional certificate issued No.................................................................... on....................................................................

Examiner of Masters and Mates

Mercantile Marine Department

N. FINAL ASSESSMENT PRIOR CERTIFICATION

Medical Fitness

Pre-Sea Training Complied

Structured on Board Training N/A

Sea-Service Requirement Complied

Written Examination (Assessment) Yes

Oral Assessment Yes

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 Modular Courses Complied

Eligibility Yes

Certificate for Competency Master of a Foreign Going Ship as recommended by Mercantile Marine Department may be issued.

Assessor at Directorate General of Shipping for Masters and Mates.

Remarks_____________________________________________________________________

Chief Examiner
(Masters and Mates)

SB/MMD(DL)/2022/10009118

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