FORM 29
(See Rule 72)
GOVERNMENT OF INDIA
MINISTRY OF PORTS, SHIPPING AND WATERWAYS
DIRECTORATE GENERAL OF SHIPPING
Application for Examination and Assessment for certificates under Merchant
Shipping (Standards of Training, Certification and Watch-keeping for Seafarers)
Application No. : SB/MMD(DL)/2025/10011631 Received Date :20/02/2025
A. Grade of Examination : Second Mate of a Foreign Going Ship
Place of Examination : MMD DELHI
1. Full Name : ROHIT JAISWAL
(Block letters)
2. Permanent Address : 42-A Madhupuram Colony Bithauli Khurdsitapur Road/Iim Road Lucknow,Bhitauli
SB/MMD(DL)/2025/10011631
Khurd,226020, Lucknow,Uttar Pradesh,India
3. Present Address : 42-A Madhupuram Colony Bithauli Khurdsitapur Road/Iim Road
Lucknow,Lucknow,226020 Uttar Pradesh,India
4. Telephone Number : 9129511002
(with STD Code)
5. Nationality : INDIAN
(Proof to be produced)
6. Passport Number : T1810267
7. Date and Place of Issue : 12/07/2019 At LUCKNOW
8. Continuous Discharge : MUM 405286
Certificate (C.D.C)
Number
9. Date and Place of Issue : 20/12/2019 At MUMBAI
10. Date of Birth : 24/03/2001
(Proof to be produced)
11.Place of Birth : LUCKNOW,UTTAR PRADESH
12.Personal Identification : MOLE ON LEFT SHOULDER
marks
13. INDos No : 19NL3565
14. Email Id : ROHITJ2403@GMAIL.COM
Note : Any Person who makes, causes to be made or assists in making any false representation for the purpose of obtaining for himself /
B. DETAILS OF SCHOLASTIC EDUCATION :
(Separate sheets must be attached)
1.Scholastic Education Level : 10+2 (HSC/Intermediate/equivalent)
2.Principal Subjects : English, Hindi, Physics, Chemistry, Mathematics, Ph Ed.
3. Year of Passing : 2018
4. School/College/ Board : Kendriya Vidyalaya IIM CBSE
5. Address of the Institution : Prabandh nagar, Lucknow
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C. DETAILS OF PRE-SEA TRAINING / MARINE ENGINEERING WORKSHOP :
(Separate sheet must be attached )
1. Training Institute : Samundra Institute of Maritime Studies
2. Address of the Institution : Samundra Institute of Maritime Studies ,Takwe-Khurd,
Mumbai-Pune Highway (NH4),410405 sims.lnv@samundra.com,02114399500,02114399600
3. Attended From : 01/02/2019 To 31/01/2020
4. Result : PASS
5. Courses Attended : Diploma In Nautical Science
D1. DETAILS OF SEA-GOING SERVICE (FOR DECK DEPARTMENT PERSONNEL) :
Port of Trade: Period
Gross
Name of Registry/ NCV/ FG/
Type Tonnage Rank From To Remarks
Ship Official Coastal
Number Months
Days
Special Category : 1.Nature
of watch keeping - Assistant
EVER FOND Container Ship 116295 FG Deck Cadet 04/03/2024 08/09/2024 6 6
Officer of Navigational
Watch,
Special Category : 1.Nature
of watch keeping - Assistant
MARLIN AMMOLITE Oil Tanker 29805 MAJURO FG Deck Cadet 20/03/2023 13/08/2023 4 25
Officer of Navigational
Watch,
SB/MMD(DL)/2025/10011631
Special Category : 1.Nature
of watch keeping - Assistant
PLATYTERA Product Tanker 26900 VALLETTA FG Deck Cadet 08/10/2021 22/06/2022 8 16
Officer of Navigational
Watch,
E-1 REPORT ON STRUCTURED ON-BOARD TRAINING :
Phase No Date Of Name of Master Details Of Certificate Of Competancy
SSTPOC 08/09/2024 EXECUTIVE SHIP 206037112192723
MANAGEMENT PVT
E-2 REPORT OF DESIGNATED COMPANY TRAINING OFFICER :
Signature :
Name : Certificate No. :
E-3 REPORT OF HEAD OF ASSESSMENT CENTRE :
Signature :
Name : Official Stamp :
F. REPORT OF ASSESSMENT CENTRE :
POST-SEA APPROVED EDUCATION AND TRAINING AT APPROVED INSTITUTION LEVEL
2M(Operational)/1M&M(Management)
Function /Part Institution From To Remarks
Fosma Maritime Institute & Research Organisation 15-OCT-2024 14-FEB-2025
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F-2 REMARKS OF HEAD OF ASSESSMENT CENTRE :
ELIGIBILTY FOR OPERATIONAL/MANAGEMENT LEVEL(Phase I & II)
ELIGIBILITY FOR WRITTEN FUNCTION I/II/III/ASM
ELIGIBILTY FOR ORALS FUNCTION I/II/III/ASM
* Online application may be provisionally approved subject to verification of Originals during Orals
Signature :
Name : Official Stamp :
G. PARTICULARS OF STCW CONVENTIONS MODULAR COURSES (POST-SEA) :
STCW Reg. / Period
Sr. Validity
Courses STCW Code Cert. No. Approved Institution
No.
No From To
Centre for Maritime Education And
1 Advanced Training in Fire Fighting A-VI/3 1010036211230465 26-DEC-2023 29-DEC-2023
Training
Proficiency In Survival Craft and Rescue Centre for Maritime Education And
2 A-VI/2-1 1010036211230466 19-DEC-2023 23-DEC-2023
Boats Training
HSNA Maritime Education And
3 Medical First Aid A-VI/4-1 1030086411230011 04-DEC-2023 07-DEC-2023
Research
SB/MMD(DL)/2025/10011631
Electronic Chart Display and Information Centre for Maritime Education And
4 10100321123230112 30-OCT-2023 11-NOV-2023
Systems Training
5 Refresher Training for Proficiency in FPFF 2010046122230275 TS Rahaman 24-OCT-2023 24-OCT-2023 23-OCT-2028
6 Refresher Training for Proficiency in PST 2010046112230275 TS Rahaman 23-OCT-2023 23-OCT-2023 22-OCT-2028
Centre for Maritime Education And
7 General Operator`s Certificate for GMDSS 2010044211230175 02-OCT-2023 14-OCT-2023
Training
Centre for Maritime Education And
8 Automatic Radar Plotting Aids A-II/1 1010032122230085 25-SEP-2023 29-SEP-2023
Training
Centre for Maritime Education And
9 Radar Observer Simulator A-II/1 1010032121230084 13-SEP-2023 23-SEP-2023
Training
Basic Training for Liquified Gas Tanker Cargo Samundra Institute of Maritime
10 2060375121210025 13-JAN-2021 18-JAN-2021
Operations Studies
Basic Training for Oil and Chemical Tanker Samundra Institute of Maritime
11 2060375111210015 05-JAN-2021 11-JAN-2021
Cargo Operations Studies
Samundra Institute of Maritime
12 Fire Prevention & Fire Fighting A-VI/1-2 206037307191011 18-JUL-2019 31-JUL-2019
Studies
Samundra Institute of Maritime
13 Personal Survival Techniques A-VI/1-1 206037307191011 18-JUL-2019 31-JUL-2019
Studies
Samundra Institute of Maritime
14 Elementary First Aid A-VI/1-3 206037307191011 18-JUL-2019 31-JUL-2019
Studies
Samundra Institute of Maritime
15 Personal Safety & Social Responsibilities A-VI/1-4 206037307191011 18-JUL-2019 31-JUL-2019
Studies
Security Trng. for Seafarer with Designated Samundra Institute of Maritime
16 206037148191010 16-JUL-2019 17-JUL-2019
Security Duties Studies
H. PREVIOUS CERTIFICATE ( Issued in India or elsewhere, If none state so) :
If any time suspended or cancelled, state
Place & date of Examination
Number Certificate
Class /Grade
Details Examination Issue Date
Court of Authority
Date Cause
I. DECLARATION TO BE MADE BY THE CANDIDATE :
I hereby declare that the particulars contained in the form are correct and true to the best of my knowledge and belief
and that the papers enumerated and sent with this form are true and genuine documents given and signed by the person
whose name appears on them. I further declare that Section D contains a true and correct account of my sea-going service
without exception and I make this declaration conscientiously believing the
ROHIT JAISWAL The above declaration was signed in my presence.
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ROHIT JAISWAL
Signature of the candidate Examiner of Masters and Mates
Mercantile Marine Department.........................District
J. REQUEST FOR ALLOTMENT OF SEATS FOR EXAMINATION :
Sign of
Sign of
Fees Paid Written Papers Orals Candidate
Examiner
Applied
Month Grade
for
Referance No CARGO CARGO/
Amount NAV1 NAV2 NAV3 NAV4
/ ASM
SOF1 SOF2 NAV
ASM
SOF
& Date
YUR325321701
MMD MAR-2025 SECOND
MATE
6000 64 20/02/2025 Y Y Y Y Y Y Y Y Y
DELHI
SB/MMD(DL)/2025/10011631
YUR325628572
MMD MAY-2025 SECOND
MATE
1000 71 24/04/2025 Y
DELHI
K 1. Sight Test :Date of Examination : _________________Result _____________Signature of Examiner
K 2. RESULT OF EXAMINATION :( for official purpose only) :
Name of Examiner
No. Written Papers Orals Signal
of O : Oral , W :Written
Atte Month Grade
mpts CARGO/ CARGO/
NAV1 NAV2 NAV3 NAV4 SOF1 SOF2 NAV SOF
ASM ASM
O-CAPT. POORAN CHAND
MEENA
MAR-2025 SECOND
1 PASS FAIL PASS PASS PASS FAIL FAIL PASS FAIL
MATE
MAY-2025 SECOND
2
MATE
Note :
Second Mate (FG) / NWKO-NCV : NAV 1: Terrestrial and coastal Navigation, NAV 2: Celestial Navigation, NAV 3: Meteorology, NAV 4: Bridge Watch Keeping and Emergencies.
First Mate (FG / NCV ): Phase I: NAV 1:Terrestrial and coastal Navigation. NAV 2: Meteorology, SOF 1: Ship Safety, Damage Control and Management of Personnel, SOF 2: Naval
Architecture Paper I.
First Mate (FG / NCV ) Phase II: NAV 1: Navigation AIds Including compasses, NAV 2: Bridge Watch Keeping . Ship Handling and Emergencies , NAV 3: Engineering Knowledge ,
Instruments and Control Systems , SOF 1: Naval Architecture Paper II, SOF 2: Marine Legislatoin .
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L. REPORT OF EXAMINATION CENTRE
1. I hereby certify that Jaiswal Rohit has satisfactory produced testimonials and proof of sea-going service/watch
keeping service/approved workshop training as required for the grade.
2. The candidate complies with the examination of the Merchant Shipping Standards (Standards of Training
Certification and Watch-keeping for Seafarers) Rules, 1998 for the grade of Second Mate of a Foreign Going
Ship
3. The candidate has passed his examinations for the functions as under :
Function
Phase Level
Written Written Examiner Oral Oral Examiner
MAR-2025 MAR-2025
CARGO CAPT. POORAN CHAND MEENA
MMD DELHI MMD DELHI
M. FOR THE CHIEF EXAMINER OF MASTERS AND MASTES
1. I hereby certify that Jaiswal Rohit born at Lucknow,Uttar Pradesh on 24.03.2001 has satisfactory produced his
testimonials and proof of Sea-going Service/Watch Keeping Service.
2. The candidate complies with the Merchant Shipping (Standards of Training Certification and Watch-keeping for
Seafarers) Rules, 1998 for the grade of Second Mate of a Foreign Going Ship
SB/MMD(DL)/2025/10011631
3. The candidate has passed the examination of the functions as under :
Phase Level Function Sign. of Examiner with Remarks
Written Oral
MAR-2025 MAR-2025
CARGO
MMD DELHI MMD DELHI
The candidate meets the requirements be eligible to be issued the Certificate of Competency as ...............................................
provisional certificate issued No.................................................................... on....................................................................
Examiner of Masters and Mates
Mercantile Marine Department
N. FINAL ASSESSMENT PRIOR CERTIFICATION
Medical Fitness
Pre-Sea Training Complied
Structured on Board Training N/A
Sea-Service Requirement Complied
Written Examination (Assessment) Yes
Oral Assessment Yes
Modular Courses Complied
Eligibility Yes
Certificate for Competency Second Mate of a Foreign Going Ship as recommended by Mercantile Marine Department may be issued.
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Assessor at Directorate General of Shipping for Masters and Mates.
Remarks_____________________________________________________________________
Chief Examiner
(Masters and Mates)
SB/MMD(DL)/2025/10011631
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