GMP Maritime & Petroleum Services

Seafarers Application Form

DATE OF APPLICATION: 03-Jun-2023

POSITION APPLIED FOR: Maintenance Manager- Plant Machinery & Vehicle

DATE AVAILABLE FOR SERVICE: 01-Jul-2023

PERSONAL INFORMATION

First Name : ROHIT Family Name : TIWARI

Middle Name : KUMAR Birth Date (dd/mm/yy) : 01/07/1989
Nationality : INDIAN Birth Place : SATNA, MP, INDIA
Marital Status : MARRIED Religion : HINDU
Height (cm) : 176 Weight (kg) : 90
Shoes size : 10 UK Uniform size : L
Nearest Airport : DOHA, QATAR
ADDRESS (include telephone country & area codes, advise also secondary or contact addresses if any)
Mobile Number +974-30544727 E-Mail address rohitomtiwari@hotmail.com
Address DOHA, QATAR Residence Number 28935631510
NEXT OF KIN INFORMATION (person to contact in case of emergency & insurance beneficiary)
Name POOJA Relationship WIFE
Nationality MYANMAAR Mobile Number +974-66548162
Address DOHA, QATAR E-Mail Address Poojha.psmile@gmail.com
REMARKS
English Language Skills Spoken: Good Written: Good
Other Foreign Languages Hindi
Marlins Test
CES Test
ADNOC APPROVE
ARAMCO APPROVE
Professiona lSchool /Academy/ Bachelors of Engineering
Mechanical Engineering

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Seafarers Application Form
Course / Period (From – To) From 200 to: 2010

Foreign Crew Experience

(specify nationalities)
FurtherRemarks MMUP UPDA QATAR Certified Mechanical Engineering

A. TRAVEL DOCUMENTS AND COC

Document Name (Description) Document Number Country of Place of Date of Issue Expiry Date
Issue Issue
Passport L8151143 INDIA BHOPAL 26/03/2014 25/03/2024
Seaman’sbook (National)
Seaman’sbook (FlagState)
Endorsement (FlagState)
CertificateofCompetency
CertificateofEndorsement
Certificateof GMDSS
Endorsementof GMDSS
Medical Certificate
Vaccinationof Yellow Fever
Visa – Other (Work/Residence/Permits) 28935631510 QATAR DOHA 22/11/2015 23/11/2023
Covid-19 Vaccination 28935631510/PHIZER QATAR DOHA 29/12/2021 THIRD DOSE
B. TRAINING CERTIFICATES
Certificates Document Number Country of Place of Date of Issue Expiry Date
Issue Issue
BST – Basic Safety Training
PSSR – Personal Safety & Social
Responsibility
PSCRB – Proficiency in Survival Craft and
Rescue Boat
PST – Personal Survival Techniques
Ship Security Officer (SSO) / STSDSD
FPFF – Fire Prevention & Fire Fighting
EFA / BFA – Elementary First Aid / Basic
First Aid

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Seafarers Application Form
Medical Care
Personal Seurvival ,Search and Rescue
Prevention & Combating of Marine
Pollution
Able Seaferer Deck
Deck/EngineWatchKeeping
SAT - Security Awareness Training
Hazardous Material
Bridge/Engine Resource Management
Ship Simulator & Bridge/Engine
Teamwork
BASIC TRAININIG FOR OIL AND
CHEMICAL TANKER CARGO OPERATION
Radar Simulator Course
Automatic Radar Plotting Aid
Global Maritime Distress and Safety
System
General Operator Course
D.P. course (Induction, Simulator,
Limited, Full)
SDP Maintenance

HighVoltage
H2S
BOSIET / HUET
ISM Code
Crane Operator Certificate

Cook Certificate

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VESSEL ENGINE VESSEL FLAG OWNER RANK AREA SIGN-ON SIGN-OFF SERVICE
NAME DATE DATE

DWT TYPE NAME / BHP RECENT RECORDS FIRST mm dd

TotalDays : ____________

D-REFERENCES
NAME OF PERSON COMPANY NAME COUNTRY TEL /FAX NO. EMAIL ID.
 Mr. Elie – PMV  Papillon Contracting &  Qatar  +974-  
Manager Services 77790772
 Mr. Abdul Wahid –  QD-SBG Construction  Qatar  +974-  
PMV Operation 33115999
Manager

APPLICANT’S SIGNATURE

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Seafarers Application Form

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