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Contact No.: Email:

Institute Name: Click or tap here to enter text.

Personal Details:
Passport No: INDOS No.: Nationality:
Date of Birth : Place of Birth : Eye Color:
Using lens or Glasses: Yes (If yes Eye Vision: Language Known: hindi, english,
mention vision) marathi

Weight: Kg Hight: Cm Waist: 0 Cm

Chest: Cm BMI: COVID-19 Vaccination: Both Dose -
Covishield / Covaxin
Any Past Medical History (Any surgery, allergies, illnesses, etc.) :
Family medical history (Cancer, allergies, High / Low Blood pressure):
Permanent Address:

Post Applied For: Deck Cadet

Academic Qualifications:
Qualification Passing Year Percentage (%) Board/ University

PCM 10+2 (%) - Physics (10+2) : Chemistry (10+2) : Mathematics (10+2):

English (10+2) :

Graduation Course : B. Tech Marine Engineering

Semester Marks:

SEMESTER 1: SEMESTER 5:
SEMESTER 2: SEMESTER 6:
SEMESTER 3: SEMESTER 7:
SEMESTER 4: SEMESTER 8:
CGPA TILL LAST SEMESTER :
STCW Courses details:
Elementary/ Medical First Aid/ Medicare Not Done Security Training for Sea Farers With Not Done
Designated Security Duties
Personal Safety & Social Responsibility Not Done Petrol Tanker Familiarization Not Done
Fire Prevention and Fire Fighting Done Chemical Tanker Familiarization Not Done
Personal Survival Techniques Done Gas Tanker Familiarization Done

Family Details:

Father Occupation:
Mother Occupation:
Brother / Sister Occupation:

Any Relative in Marine Field:

Any Educational Loan:

Declaration: I hereby declare that the information given in this application is true and correct
to the best of my knowledge and belief.

Date : Signature: Click or tap here to enter text.