Last updated date : 02/12/2021 12:37 PM Date : 26-Nov-2022

Seafarer Profile

Personal Details
Surname / Last Name : MUTHUSELVAM

Given Name : KARTHIKEYAN

INDoS No. : 21NM1886 Discipline : Nautical

Gender : MALE

Date of Birth : 04/06/2004

Place of Birth : SIVAGANGA Birth State : Tamil Nadu

Birth Country : India Nationality : Indian

Address Details
Present Address Permanent Address
Address : NO.1521, INDHIRA NAGAR, Address :

: III STREET, KALLAL :

: KARAIKUDI TK :

City : SIVAGANGA City :

Pin : 630305 Pin :

State : Tamil Nadu State :

Country : INDIA Country :

Telephone No. : Telephone No. :

Mobile No. : 9790292893

Email Id : kallalmail@gmail.com

Physical Details

Height (in Cms) : Hair Color :

Eye Color : Complexion :

Identification Mark : MOLE IN LEFT THUMB FINGER

Authorised Documents
1 . Document Type : INDoS

Document Type : INDoS

Document Number : 21NM1886 Issued Date : 09/11/2021
Valid Upto : Issued At :

Total no of record in Authorised Documents : 1

Report generated on : 26/11/2022 6.23 PM Page 1 of 2

 DECLARATION TO BE MADE BY CANDIDATE :
I hereby declare that the particulars entered in the form are correct and true to the best of my knowledge and belief and that the
papers enumerated in this form are true and genuine documents given and signed by the person whose names appears on them. I
further declare that Seagoing service information entered is a true and correct account of my sea-going service without exception and
I make this declaration conscientiously believing the same to be true. The documents in original will be presented to the examiner at
the time of taking oral examination or at an earlier time when asked by the department.

Signature of the candidate

Date :

This is an electronically generated document hence it does not require any signature of DGS Officials.

Report generated on : 26/11/2022 6.23 PM Page 2 of 2