> GOVERNMENT OF INDIA MINISTRY OF SHIPPING. GOVENRMENT SHIPPING OFFICE APPLICATION FOR CONTINUOUS DISCHARGE CERTIFICATE (CDC) [Application No. SMO (720227227416 “Application Date PO NOWBOED lOffice Applied To _: SHIPPING MASTER OFFICE MUMBAI Personal Details (Name of the Candidate = ROY KESHAV KUMAR KUMAR Father's namo :SACHINDRA ROY Sex Male Date of bith Place of bith BITHOULL Nationality 1NDOS No. + 212NS560 Indos issue Date Height (in ems ) 172 Colour of eyes BLACK [cotour of hair :BLACK ldontiication Marks :AMOLE ON LEFT ARMS. Valid Passport No. 9664835 Passportissue Place: CHENNA! Passport Issue Date ISMAR-2022 Passport Expiry Place: 14MAR2032 bth Standard Pass Cerificate Details [Name of Board Year of Passing Certfcate No. Permanent Address Details House No. iLL Steet Vilaga/Post office ITHOULL District, Stato sinar Pin Code Phone No. with STO Code: 08294500134 Nearest Patice Station [Email + keshavekumar1384@gmai.com Mobile Ne- + 9360405227 Wexd-OF Kin Detalls jame of Next of Kin 7 SACHINORA ROY House No. NILE =| lationship with Seafarer: FATHER VilagerPost OfficrTehsit: BITHOULL 2 ML state + har istit + DARSHANGA Phone No. with STD Code: 05294500194 Pincode ser : <_ : faa ia ereonse aT , ‘Name of iatiote 5 "CHC MARITIME ACADEMY, CHENNAL [Basic Safety Training (STCW-BASIC) ee (conPUS) ci Sey TT Sel wines Szuy Ostes | sopgssazurs | 220002 [eG HAsTE RADE CHEN [fsrsosoy sole * PUS) _ re jedical Cortificate a ae [Name ofthe Doctor ~~ DRRAMOL SUBHASH MORE [DGS Approval No. ofthe Doctor: MAHIRAWO2/20‘7 Place of issue of Medical Certificate: NAVI MUMBAI Dae of save of Medical Certiieste_: VANOV-2022 Date of Expiry of Medical Certifiate_:13-NOV-2024 al Et Fees Details “Amount (Rs) 7700 Payment Mode 7 ePayment Payment Details 2 Fees not paid a ‘tached Document — Documents fo be Unloaded | San con af sone ne applation a Py sem X25 cm) photograph wih Gear white Background face covering TO% ess deals and signature of passport author are oo nature of passport aury Sslored scanned copy of onal 1h Standard Pass Cetfeate/Marishoat Coloured scanned cy of rina Medal Finess Getic rom DGS Approved Dado (Append) Soa eee copy of ogal permanedt addres proof (ay ane of them Passport Aadhaar Card Eleton Commission Photo 1D cad. and [7 _}Pemanent ring License) Declaration ectaration & Undertaking of Candidate (ROY KESHAV KUMAR KUMAR, 1172022 12.07 PM Roport generated on: 2011/2022 Page 1 of2 © scanned with OKEN Scannerfalco any mater reasons to believe that} of eons a ste ay material fomnaton and he Shipping Maser N ener iF Discharge Cert sm GDC wil be cancolofaspondea fori as parte provisions conaines ) Rie, 2017 a ered | Roport generated on: 20/11/2022 12.07 PM — © scanned with OKEN Scanner