OPS/118-E

MOL Maritime (India) Pvt. Ltd. Rev. No.: 6.3

09 Nov 2022
Notice of Readiness – Engine Officers Page 1 of 1

Please note below prior filling up NOR form:

1. NOR form to be submitted 4 weeks prior to the expiry of vacation entitlement.
2. Acceptance of your Notice of Readiness is subject to validity of your documents.
3. In case refresher is done, do carry base certificate along with refresher certificate.

To: MOL Maritime (India) Pvt. Ltd. Mumbai Delhi Chennai Kolkata
Name: Rank: Last Vessel Served:
From Date: To Date: Sign Off Reason: My vacation entitlement is up to: I am ready to rejoin from:

Address: Tel: (with

STD code):
Mobile:
E-mail:

Yes / No / Yes / No /
Document Document
NA / Validity NA / Validity
Yellow Fever (Lifetime without lamination) Yes / No Ship Security Officer / STSDSD Yes / No
COVID-19 Vac. ( Booster Final First) Issue Date High Voltage Course - OPR; MGMT Yes / No
Chicken Pox Vac. (for Dry Pool Officers) Enter Validity High Voltage Limitation deleted from CoC Yes / No / NA
Passport - (Minimum 13 months validity) Enter Validity MOL Behavior Based Safety Course Yes / No / NA
(Minimum 4 side to side pages required) No. of Pages Risk Management & Incident Investigation Yes / No / NA
Type - C1/D Enter Validity Shipboard Safety Officer Course Yes / No / NA
US Visa:
Type B1 / B2 Enter Validity MARPOL Elec.Oil Record Book (eORB) Yes / No / NA
AMCV - Australian Maritime Crew Visa Enter Validity LNG Cargo Control Room Resource
Yes / No / NA
Seafarer Identification Document (SID) Yes/No Management (for MOL LNG Gas Engineers)
CDC – National Enter Validity National GAS DCE
CDC-No. of blank pages (min. 2 pgs. Reqd.) Enter Nos. of Advanced (Level II)
Enter Validity
Place of Birth mentioned in CDC: Y/N pages Basic (Level I)
Japanese Orange Book MOL Standard Electric Course Yes / No
Enter Validity
For Dry Pool Officers only Electrical Skill Development Course
Yes / No
Cert. of Competency – National (For class IV license holders only)
Enter Validity
Class I Class II Class IV ETO STS Operations – for Gas Engineer
Yes / No
Corrigendum for para 9 to para 11 Yes / No / NA (MOLLNG Q-Flex and Steam Vessels)

RUTC - STCW 78-95 STCW 95–2010 Yes/No/NA #0260 – Behavior Based Safety
Seagull CBTs #1326 – MOL Shipboard Manners
Medical First Aid completed #0390 – Harassment and Bullying
Enter Validity
(Refresher to be done within last 5 years) #4093 – Cyber Security Awareness

PSSR Issue Date Union Membership Fees paid upto Enter Validity
Last Updated
PST – Base Cert. Refresher Enter Validity Seafarer’s Profile Registration
on
Days
PSCRB – Base Cert. Refresher Enter Validity NRI Limitation
Required
AFF – Base Cert. Refresher Enter Validity NRE Account Yes / No

FPFF – Base Cert. Refresher Enter Validity Other, if any

I have checked and hereby confirm that my First Name, Surname / Last Name, Place of Birth (with spelling), Date of Birth and
signature are same and tally in my Passport, CDC, CoC and US Visa or any other visas including AMCV etc.
I have checked and hereby confirm that my current passport details including other required information are uploaded on my
Seafarer Profile on E-Governance platform and my INDoS No. is not revoked. (for Indian Seafarers only)
Remarks, if any:

Date: Place: Officer’s Signature:

For office use:

Date NOR accepted: NOR accepted by: