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Qship Application Form

The document is a Seafarers Application Form from QSHIP Maritime Management Pvt Ltd, detailing personal and professional information required for seafarers. It includes sections for personal details, documents, qualifications, and sea service records. The form also requests information about the applicant's next of kin and various certifications related to maritime safety and training.

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mohammedsafnan18
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46 views1 page

Qship Application Form

The document is a Seafarers Application Form from QSHIP Maritime Management Pvt Ltd, detailing personal and professional information required for seafarers. It includes sections for personal details, documents, qualifications, and sea service records. The form also requests information about the applicant's next of kin and various certifications related to maritime safety and training.

Uploaded by

mohammedsafnan18
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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QSHIP MARITIME MANAGEMENT PVT LTD

(RPS-MUM-237 Approved by DG Shipping valid till 03/11/2026)


819 Mainframe Royal Palms Complex Goregoan E Mumbai 400065 Tel: 022-28769034 /28791462 …………………………………….
Date:

Seafarers Application Form


Applied for : Salary
Surname : First Name:
Documents Name
Nationality: DocumentDate
No of Birth : Date of Issue Date of Expiry Place
PHOTOof Issue
Address:
Passport
Seaman Book
Indos
PPE No :
Details Coverall size : Safety Shoes Size :
Covid-19 Vaccine Certificate
Nearest Airport :
Certificate of Competency/Proficiency COC /COP
Full name of Next of Kin:-
GMDSS Relationship: -
GSMDSS
Contact No. : Endorsement Email:
Proficiency In Medical Care (P.M.C)
Proficiency In Survival Technique P.S.T
Personal Survival & Social Resp. P.S.S.R
Elementary First Aid EFA/MFA
Proficiency In Survival Rq.Bt. P.S.C.R.B
Fire prevention and fire fighting FPFF/AFF
Security Training for Seafarers with Designated Security
Duties / Ship Security STSDSD/SSO
Watch keeping WK
Yellow Fever YF
Oil tanker Familiarization OTFC
Tanker Endorsement TE
Dangerous C. Endorsement DCE
Chemical Tanker Familiarization C.T.F
DP Maintenance/DP License DPM/DPL
DP Advance Courses
ROC/ARPA
Academic Qualification
Pan Card No

EVIOUS SEA SERVICE

SEA SERVICE RECORDS:


Company Vessel Name Vessel Rank GRT / Engine type From To Total
Type NRT & BHP Months

Seafarers Signature Checked & verified by

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