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. : AT/MMD(C)/2020/10005994 Received Date :17/03/2020

A. Grade of Examination : Second Mate of a Foreign Going Ship

Place of Examination : MMD CHENNAI

1. Full Name : ASHISH RANJAN

(Block letters)

2. Permanent Address : Vill+P.O:-Khiriaon, P.S:-Kachwavia:-Nasriganj,Khiriaon,821310, Rohtas,Bihar,India

AT/MMD(C)/2020/10005994
3. Present Address : C. O. -Jeetu Singh,Near Vimal Utsav Palacefriends Colony, Bajaj
Showroom,Pakri,Ara,802301 Bihar,India
4. Telephone Number : 9162419497
(with STD Code)
5. Nationality : INDIAN
(Proof to be produced)
6. Passport Number : R7645434
7. Date and Place of Issue : 13/02/2018 At PATNA
8. Continuous Discharge : MUM 314261
Certificate (C.D.C)
Number
9. Date and Place of Issue : 07/06/2018 At MUMBAI
10. Date of Birth : 25/09/1997
(Proof to be produced)
11.Place of Birth : KHIRIAON
12.Personal Identification : DEEP MARK ON LEFT CHEEK
marks
13. INDos No : 16NL2039
14. Email Id : ASHISH7540RANJAN@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 : Graduate (Bachelors Degree)
2.Principal Subjects : Nav.,Bewk, Naval Arch.,Sot, Cw&Stw,&Mecs
3. Year of Passing : 2018
4. School/College/ Board : T. S. CHANAKYA IMU NAVI MUMBAI CAMPUS INDIAN MARITIME UNIVERSITY
5. Address of the Institution : PALM BEACH ROAD, NEAR KARAVE VILLEGE,NERUL, NAVI MUMBAI,
MAHARASHTRA-400706
C. DETAILS OF PRE-SEA TRAINING / MARINE ENGINEERING WORKSHOP :
(Separate sheet must be attached )

1. Training Institute
2. Address of the Institution

3. Attended From
4. Result
5. Courses Attended

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
Special Category : 1.Nature
Cadet(Nautical of watch keeping - Assistant
TENJUN Oil Tanker 159927 37802 TJ FG 11/04/2019 24/12/2019 8 14
Science) Officer of Navigational
Watch,
Special Category : 1.Nature
Cadet(Nautical of watch keeping - Assistant
TSUGARU Oil Tanker 160152 142496 FG 30/10/2018 23/02/2019 3 25
Science) Officer of Navigational
Watch,

AT/MMD(C)/2020/10005994
E-1 REPORT ON STRUCTURED ON-BOARD TRAINING :

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

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

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
Proficiency In Survival Craft and Rescue
1 A-VI/2-1 2010046211200105 TS Rahaman 09-MAR-2020 13-MAR-2020
Boats

2 Medical First Aid A-VI/4-1 2010046411200104 TS Rahaman 04-MAR-2020 07-MAR-2020

Electronic Chart Display and Information

3 201004165200021 TS Rahaman 24-FEB-2020 28-FEB-2020
Systems

4 Automatic Radar Plotting Aids A-II/1 201004024200021 TS Rahaman 17-FEB-2020 21-FEB-2020

6 AT/MMD(C)/2020/10005994
Radar Observer Simulator

Advanced Training in Fire Fighting

A-II/1

A-VI/3
201004023200021

201004082200042
TS Rahaman

TS Rahaman
03-FEB-2020

27-JAN-2020
14-FEB-2020

31-JAN-2020

Augmentation of FPFF (Practical Tanker Fire BPMA/AUGM/1078/2018

7 BP Marine Academy 18-JUL-2018 18-JUL-2018
Fighting)

Basic Training for Liquified Gas Tanker Cargo

8 BPMA/LGT/509/2018 BP Marine Academy 09-JUL-2018 13-JUL-2018
Operations

Basic Training for Oil and Chemical Tanker BPMA/OILCHEM/2175/2

9 BP Marine Academy 02-JUL-2018 07-JUL-2018
Cargo Operations 018

Security Trng. for Seafarer with Designated

10 ISPS/TSC/2017/281 IMU, Navi Mumbai Campus 23-OCT-2017 24-OCT-2017
Security Duties

11 Personal Survival Techniques A-VI/1-1 032/PST/17-18 IMU, Navi Mumbai Campus 31-AUG-2017 02-SEP-2017

12 Elementary First Aid A-VI/1-3 032/EFA/17-18 IMU, Navi Mumbai Campus 13-APR-2017 15-APR-2017

13 Personal Safety & Social Responsibilities A-VI/1-4 105/PSSR/16-17 IMU, Navi Mumbai Campus 23-MAR-2017 25-MAR-2017

14 Fire Prevention & Fire Fighting A-VI/1-2 2089/FPFF/2016 IMU, Navi Mumbai Campus 05-APR-2016 07-APR-2016

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

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

ASHISH RANJAN The above declaration was signed in my presence.

Signature of the candidate Examiner of Masters and Mates

Mercantile Marine Department.........................District
ASHISH RANJAN

J. REQUEST FOR ALLOTMENT OF SEATS FOR EXAMINATION :

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

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

AT/MMD(C)/2020/10005994
L. REPORT OF EXAMINATION CENTRE
1. I hereby certify that Ashish Ranjan 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 Second Mate 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 Ashish Ranjan born at Khiriaon on 25.09.1997 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 Second Mate 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

AT/MMD(C)/2020/10005994
Medical Fitness
Pre-Sea Training

Structured on Board Training

Sea-Service Requirement

Written Examination (Assessment)

Oral Assessment

Modular Courses

Eligibility

Certificate for Competency Second Mate 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)