Position Applied for :      Third officer                                          Date of Availabilty    07.07.
2018
Surname:                 Ramamoorthy                                                Name:           Kishore kumar
Contact Nos : Mob / L L      +91 9791087524 , 9940039216                           Email:       cool.kishkumar@gmail.com
Date Of Birth                     23.05.1993                                       Place Of Birth            Chennai
Nationality :                                                             UnmarriedMarital Status :
                   Indian
Address :       No.119A, 11 th st., North jaganatha nagar , Villivakkam ,
                chennai 600049.
Documents                                                       Number                      Place of Issue             Date of Issue            Date of Expiry
Passport                                                   K1037203                         Chennai                                            20.01.2023
                                                                                                                      30.01.2013
CDC                                                       MUM220754                       Mumbai                      23.08.2013               22.08.2023
INDOS                                                      10NL3124                       Mumbai                      18.11.2010                   N/A
Yellow Fever                                                 499                          Chennai                     13.09.2013               23.09.2023
U.S. Visa C1/D
       Documents                  Grade/Level                   Number                   Place of Issue               Date of Issue            Date of Expiry
Nat. Certificate of
Competency (COC)           Second mate FG                      IF 38798                  Chennai                     01.04.2018               09.01.2023
Oil Endorsement             Operational                                                  Chennai
                                                            CMMI/OIL/CHN/15/1795                                     17.08.2015               12.08.2020
Chemical Endorsement
Gas Endorsement
COC - Other National
Panama
Liberia
Others
CDC - Other National
Panama
Liberia
GMDSS GOC                     Operational                                               Chennai                                               25.05.2027
                                                            GOC-C-7604                                               26.05.2017
GMDSS Endorsement             Operational                 GMDSSCHN18002619               Chennai                     15.02.2018               14.02.2023
PSSR                          Operational                                                                                                      Unlimited
                                                          PSSR/8762/2012               AMET/CHENNAI                  08.08.2012
PSCRB/ PST                    Operational                                                                            20.10.2017
                                                           PSCRB/B587/04              HIMT/CHENNAI                                            19.01.2022
AFF/ FPFF                                                                                                                                     UNLIMITED
                               Operational                AFF//B578/03                HIMT/CHENNAI                    14.01.2017
MC/ MFA/ EFA                  Operational                 MFA/B995/01                                                 28.01.2017
                                                                                       HIMT/CHENNAI                                           27.01.2022
SSO / STSDSD                   Operational                SSO/B524/03                  HIMT/CHENNAI                   07.02.2018               UNLIMITED
WATCH KEEPING
CERTIFICATE
Academic Background
       Qualification                         Name of                                                                                             Grade/
                                                                             City / Country                   From                     To
        Obtained                            Institution                                                                                          Percentage
10th Std (SSLC) /
Equivalent                          Don Bosco Matric                        CHENNAI                          2007                      2008                   82.4
12th Std (Hr. Sec) /
Equivalent                          Don Bosco Matric                        CHENNAI                          2008                      2010                   76.8
Graduate / (Other)
Presea Training                    AMET UNIVERSITY                          CHENNAI                          2010                      2013                   70.3
Mates / Masters
2E/ CE Exams
Family Details ( Father & Mother / Wife & Children) :
     No.                           Name                                     Relation                   D.O.B          Sex        Passport No      Place of Issue Date of Issue        Date of Expiry
      1               RAMAMOOTHY                                       Father                     07.04.1955         MALE
      2               KALAISELVI                                       Mother                     05.01.1961        FEMALE
      3
      4
      5
Previous Sea Experience (List service for last five years OR last ten vessels. List recent vessel first)
                                                                                       Type of         Deck (Trade & DWT)                                   Period                    Months / Days
     Company's Name                          VESSEL'S NAME                                                                           Rank
                                                                                        Vessel         Engine (Type & BHP)                           From             To             Reason for S/off
         GIVENERGY                       MT SHARJAH PRIDE                              Tanker       MIDDLE EAST/41402            Deck cadet 26.01.2015 05.04.2015     Scrapped
 ADMIRAL SHIPPING LLC                    MV ADMIRAL GLORY                         Container         MIDDLE EAST/9602             Deck cadet 03.11.2015 10.11.2016 Completed seatime
Last Employer name, PIC & Contact:                              ADMIRAL SHIPPING LLC , 903B, SAMA TOWER, SHEIK ZAYED ROAD,DUBAI UAE,+971 4 3522 151
                                                                                        Summary of Sea going Experience
For all Officers: Period served on (yy/mm)
Handymax       Panamax        Cape                              Cntr- Feeder      Ctnr- +4000P/ Tanker           Aframax        VLCC              LPG/ LNG       Chemical        Others
                                                                                       1 year      3 months
For Engineer Officers only : Period served on (yy / mm)
Sulzer         B&W            MAN                               Pielstick         UEC            Doxford         Steam          UMS               CPP            Cranes
Nationality of crews sailed with : INDIAN, SRI LANKAN,IRANIAN , TANZANIAN , SUDANESE
                                                                                                                                                          Declaration by the Applicant
Are you familiar with computer based PMS ? Please specify.
                                                                 Yes, CODie SHIP MANAGEMENT SOFTWARE                                              I understand that a strict medical examination including
Have you been on board vessels during:                                                                                                            Drug and Alcohol test as per company requirements is
                                                                                                                                                  a a condition of my employment and I express my
Drydocking:        YES        New Construction :                                                 Major Conversion                                 willingness to be examined.
                                                                                                                                                  I undertake to provide the company’s medical officer
Incidents of Grounding / Fire / Explosion / Collision / Abandon Ship /                   Resue operation of                                       full details of my previous medical history. I agree that
Rescue /
Major oil Pollution / Drug Smuggling / Towed or Towing another vessel                    capsized fishing boat                                    the decision of the company medical officer is final.
                                                                                                                                                  I declare that there are no criminal/ police
Reference -Senior Deck officer - Name & Contact No                                                                                                investigations in progress against me.
Reference - Senior Engineer officer - Name & Contact No                                                                                           I confirm that all my travel documents are valid and in
                                                                                                                                                  order. I understand that if my travel Documents
Reference - Senior Rating - Name & Contact No                                                                                                     become invalid or restricted at any time during the
                                                                                                                                                  course of my employment and cannot be revalidated
Have you ever been involved in a criminal case : If yes on any of the above ,                                                                     by me under normal process, the contract of
give details:                                                                                    NIL                                              employment will terminate and all costs of repatriation
                                                                                                                                                  will be borne by me.
Medical History &
Declaration
                              Height      180                                     Weight
                                                                                                    85           Blood Group
                                                                                                                                    B+            I am /am not presently employed elsewhere.
Do you suffer or have suffered from : Diabetes / High Blood Pressure /
                                                                                                                                                  If my application is successful, I will be available to
Hepatitis / Epilepay / Nervous Disorders/ Disturbed Vision Or Hearing /
                                                                                                                                                  report at your office on or after:
Vertigo If yes, give details :                                                                    NIL
Are you a habitual user of Drugs / Narcotics / Excessive Alcohol :
                                                                                                  NIL
Is your MUI/ NUSI membership valid for current year? If Yes, provide
information                                                                                       NIL
Name Of Applicant                                                                                Rank               Third officer
                                RAMAMOOTHY KISHORE KUMAR
Date of Application                    06.07.2018                                                                    Signature of the Applicant