Please Affix

IN
Passport size
Photograph
Elegant Marine Services Private Limited
(Agents of Fleet Management Ltd.)
Our Principal’s Website: www.fleetship.com,
RPSL License No: MUM- 172
DOI: 18/09/2020 DOE: 18/09/2025
Application Form / Personnel Data Update Form
Post applied for: Willing to accept lower Rank? Yes, No Available From: / /

(A) PERSONAL PARTICULARS (AS IN PASSPORT)

First Name GUNEET Middle Name SINGH Last Name/Surname

Nationality INDIAN Date of Birth 26TH FEB 1996 Place of Birth HOSHIARPUR PUNJAB

Height 173 Weight (In KGS) 80 Smoker / Nonsmoker Yellow Fever Union Membership
(In CMS) Blood Group B+ Veg. / Non - Veg. DOI DOE BATCH /LOT No.
YES NO
Boiler Suit Size: MED / LARGE / XL / XXL Shoe Size:

Permanent Address: B 2 3 5 0 / 8 / 1 S H I V A L I K A V E N U E Local Address: M E N T I O N E D A B O V E

NEAR GULATI HOSPITAL ASLAMABAD PUNJAB
City: H O S H I A R P U R Tel.: City: H O S H I A R P U R Tel.:
Post Code: 1 4 6 0 0 1 Mobile: 7 0 0 9 5 6 4 7 2 9 Post Code: Mobile:
E-mail: g u n e e t s 0 9 0 @ g m a i l . c o m

Date of Issue Date of Expiry

Document No. Place of Issue
DD / MM/ DD / MM/
YY YY
Passport: Country N1583584 23 JULY2015 JALANDHAR 22 JULY 2025
Seaman’s Book (CDC): National MUM255503 04 JAN 2016 MUMBAI 03 JAN 2026
Seaman’s Book (CDC): Norwegian
Seaman’s Book (CDC): Liberian
Seaman’s Book (CDC): Panamanian
Seaman’s Book (CDC): Marshall Island
Other (CDC):
Valid US Visa “C1/D” Yes / No Date of Expiry: 2 6 S E P T 2 0 2 1 Passport ECNR: Yes / No
Australian Maritime Crew Visa Yes / No Date of Expiry:

Next of kin: R A J I N D E R K A U R Relationship: M O T H E R DOB: 1 S T J U L Y 1 9 6 9

Alternate next of kin:
(in case of family joining) Relationship:

Address
Tel.:
....................Family Details....................
Relationship First Name Last Name DOB Passport No. Place Issued Valid until
Spouse
Child M / F
Child M / F
* Indicate Type of Valid Visas USA / CANADA / BRAZIL / UK / Others
Anniversary date:
* Please check if visas a n d a l l d o c u m e n t s a r e v a l i d for the tenure on board, plus 6 months.

Applicant Signature: _________________________

Page 1 of 11
FORM No.: Annex 11/OPM
REV. No.: 03 / 2020
Page 2 of 11
FORM No.: Annex 11/OPM
REV. No.: 03 / 2020
(B) Education / Other Qualifications:
EDUCATIONAL QUALIFICATION
Result Grade (1st, 2nd,
10 + 2 / Degree Institution / University Year of Passing 3rd or A, B, C etc)

Dav collegiate senior sec school 2014 63%

PRE - SEA TRAINING / APPRENTICESHIP / MARINE ENGINEERING / NAUTICAL DEGREE OR DIPLOMA
Result Grade (1st, 2nd,
Pre - Sea T ra in in g T ra in in g I ns ti tu ti on / C om pa ny Na me From - To 3rd or A, B, C etc)

DNS Vishwakarma maritime institute/ 16 feb 2015 64%

Daunatic and eklavya shipping 31 jan 2016
CERTIFICATES OF COMPETENCY:
Highest Competency Certificate Held
Date of Passing Examination
Issuing A u t h o r i t y Grad Certificate No. DOI Place Valid until
National ( Country) e
applied Issued
Liberian
Panamanian
Marshall I s l a n d
Norwegian
Hongkong
Others
GMDSS 3010024211210111 24/12/21 KOLKATA NA
GMDSS ( Endorsement) GMDSSDELl22013358 13/06/22 DELHI 12/06/2027
LIST OF S.T.C.W. / OTHER COURSES DONE
Courses STCW 1995 STCW 2010 Date of Issue Date of Expiry
1) FPFF / Advanced Fire Fighting 3030166311210041 23/03/2021 NA
2) Elementary / Medical F i r s t A i d / Medicare 3030166411210041 16/03/2021 NA
3) PSSR 0100260042015 27/06/2015 NA
4) Proficiency in Survival Craft & RB / PST 3030086211210151 11/06/2022 19/04/2026
5) STSDSD VMI/DNSSTSDSD/ 16/10/2015 NA
2015/08/0815
6) CTFC / CHEMCO
7) GTFC / GASCO
8) OTFC / TASCO CURRENTLY GOING
ON
9) LCHS (Management / Operational)
10) Ship Maneuvering Simulator Course
11) Radar Observer Course / ARPA 1050152122210061 24/09/2021 NA
12) Radar Simulator Course / RANSCO 1010052121210071 17/09/2021 NA
13) BTM / BRM
14) Ship Security Officer Course
15) NIS Familiarization Course
16) C.O.C. Revalidation Course
17) INDOS No. (Mandatory Requirement)
18) STCW 2010 Refresher Courses/PST 1010056112220242 02/06/2022 01/06/2027
19) High Voltage Course
20) Seafarers Identify Documents (SID)
21) Others (Specify)
Dangerous Cargo Certification:
1. Endorsement on NATIONAL Certificate Level Number DO Place Issued Valid Until
Petroleum I
LEVEL 1 CMMI/OIL/16/13902 30/04/2016 MUMBAI
Liquefied Gas
Liquid Chemicals LEVEL1 CMMI/CHEM/16/13901 30/04/2016 MUMBAI
2. Other Endorsements

Page 3 of 11
FORM No.: Annex 11/OPM
REV. No.: 03 / 2020
Applicant’s Signature

Page 4 of 11
FORM No.: Annex 11/OPM
REV. No.: 03 / 2020
(C) SEA SERVICE: (Start from Last Vessel Served)
Flag of Type of Engine make & model & BHP/KW (For Engineers) DWT From To Total
Name of the Company Name of the Vessel (D) Rank
Vessel Vessel Cargoes Carried (For Deck Officers) dd/mm/yy dd/mm/yy M/D
GRT
Non-Fleet Management Vessels
DOEHLE DAUNATIC MT DISTYA AMEYA INDIAN CRUDE HFO 90,000 CADET 09/05/2017 02/12/2017 6M24D
EKLAVYA SHIPPING MT PRINCESS MARYAM PALAU Product FO 11000 CADET 09/10/2019 24/09/2020 11M15D

Remarks: 1 S T C O M P A N Y B A N K C R Y P T T H E N C H A N G E D M Y C O M P A N Y

Sea Service with Fleet Management Vessels

Applicant’s Signature

FORM No.: Annex 11/OPM

REV. No.: 03 / 2020
(D) Experience Matrix of Engineer Officer
Please mark ‘Y’ against your rank in the cell, if that experience is applicable to you
S.No. Crane Make C/E 2/E 3/E 4/E E/O Any B r e a k d o w n e x p e r i e n c e / Remarks
Experience on Deck / Cargo Machinery
1 Haaglund
2 Liebherr
3 IHI
4 Mitsubishi
5 NMF
6 Atlas
7 BLM
8 MacGregor
9 Any Other
Grab Make
1 SMAG Peiner
2 ORTS
Experience on Reefer Machinery / Reefer Container
1 Direct System
2 Indirect S y s t e m
3 Carrier T r a n s i c o l d
4 Thermoking
5 Daikin
6 Mistubishi
7 Any Other
Experience on Oil / Chemical / Gas Tankers
1 Framo Pumps
2 Centrilina Pumps
3 Steam Turbines
4 Any Other
Experience on Propulsion System / Maneuvering System
1 CPP
2 Bow/Stern thruster
3 Twin Screw
4 NOR Control
5 Kongsberg
6 Any Other
Experience on Auxilliary Engines
1 Yanmar
2 Daihatsu
3 Sulzer
4 MAN B&W
5 Cummins
6 Caterpillar
7 Pielstik
8 Volvo Penta
9 Any Other

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REV. No.: 03 / 2020
 S.No. Crane Make C/E 2/E 3/E 4/E E/O Any Breakdown experience / Remarks
Experience of major overhaul / breakdown
1 Drydock
2 M/E Turbocharger
3 M/E Governer
4 M/E Cyl. Liner
5 Thrust Block
6 A/E Crankshaft
7 Alternator overhaul
8 Steering Gear
9 Any Other
Experience in Disaster Management
1 Grounding
2 Collision
3 Oil Spill
4 Crank Case Explosion
5 Scavenge Fire
6 Engine Room Fire
7 Cargo Fire
8 Abandon Ship
9 Steering Failure
10 Any Other
Experience in PMS
1 AMOS
2 TM Master

Applicant’s Signature

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(E) Experience Matrix of Deck Officer
Please mark ‘Y’ against your rank in the cell, if that experience is applicable to you
S.No. Description M CO 2O 3O Cdt Any Breakdown or incident experience / Remarks

Have you sailed in the following areas ?

1 Indian Ocean Y
2 Pacific Ocean Y
3 North Atlantic Ocean Y
4 South Atlantic Ocean
5 South China Sea
6 Australian Waters
7 Mediterranean Sea
8 Black Sea
9 English Channel / North Sea
10 Singapore Straits Y
11 Panama Canal
12 Suez Canal
13 Kiel Canal
14 Great Lakes
15
16
17
Chemical / Product Tanker Tank Cleaning experience
1 Cleaned tanks after carriage of veg. oil ?
2 Cleaned tanks for Methanol carriage ?
3 Cleaned tanks MEG or similar cargoes ?
4 Cleaned tanks for Veg Oil carriage ?
5 Cleaned tanks for Jet Fuel ?
6 Changed from dirty to clean products ? Y

Gas Tanker Experience

1 Fully Refrigerated vessel
2 Fully pressurized vessel
3 Partially refrigerated vessel

Oil / Product / Chemical Tanker Experience

1 Inert Gas vessel Y
2 Crude Oil Washing Y
3 Inert Gas purging Y
4 Cleaning crude oil tanks for hot work
5 Framo Pumps operation
6 Cargo Heating Y
7 Framo Pump damage
8 Over / Under pressurization of tanks Y
9 Cargo contamination

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 S.No. Description M CO 2O 3O Cdt Any Breakdown or incident experience/Remarks

Bulk Carrier Experience

1 Hose test for hatch covers
2 Bilge valve testing
3 Ballasting of cargo hold
4 Disposal of cargo residues
5 Draft survey cargo calculations
6 Over / Under pressurization of Holds
7 Cleaned Holds for Grain carriage ?
8 Cleaned Holds for Fertilizer carriage ?

Experience of major overhaul / breakdown

1 Drydock
2 Windlass damage / Loss of Anchor
3 Sterring Gear failure Y

Experience of Special circumstances & Disaster Management

1 Grounding
2 Collision
3 Oil Spill Y
4 Crank Case Explosion
5 Scavenge Fire
6 Engine Room Fire
7 Cargo Fire
8 Abandon Ship
9 Steering Failure Y
10 Freezing Weather
11 Heavy weather / TRS
12 Fog / Restricted visibility Y

Experience in PMS
1 AMOS
2 TM Master

Applicant’s Signature

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 (F) GENERAL:
(1) Have you ever been denied a foreign visa or been deported from any country? / No
If yes, state which country and reason (if known) :
(2) Have you been the subject of a court of enquiry or involved in a maritime accident? / No
If yes, please attach details
(3) Have you ever signed off a ship due to medical reason within last 3 years? / No
If yes, please provide following details :

Name of vessel Date of occurrence Place of occurrence

Reason for sign off :

(4) Have you ever been involved in any criminal activity or have pending criminal case? / No
If yes, please provide details.

(5) Have you ever been involved in any navigational incidents in last 24 months? / No
If yes, please provide details.

(6) Are you Currently under Medical Treatment or Taking Medication for Existing conditions? / No
If Yes, please provide details
Comments on above ____________________________________________________________________

(D) Last drawn salary in USD:

(E) References
Please give referees from two recent employers who we may contact for references
Reference 1 Reference 2
Name of Company FLEET MANAGMENT
Name of Person to contact SARBJEET SINGH
Address HOSHIARPUR

Country INDIA
Telephone

I Do hereby declare that all information furnished is true to best of my knowledge and belief.

Received acknowledgement of Application form

Date : 07/10/2022 Rank : 3RD OFFICER Applicant’s Signature

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(H) FOR OFFICE USE ONLY

STAGE II (Checked by : Personnel Officer) Name : Sign

Documentation c h e c k s
a) Copies of all STCW certificates received? Yes / No
b) Copy of all valid Certificates of Competency including Endorsements received ? Yes / No
c) Copy of National or Main Certificate of Competency verification certificate received? Yes / No
d) Copies of Passport including all valid visas received? Yes / No
e) Copies of Seaman’s Book including all pages containing sea service received? Yes / No
f) Copies of Vaccination Book received? Yes / No

Comments regarding non-receipts :

STAGE III ( Assessed By : Marine / Tech. Superintendent / Manager / Deputy General Manager / General Manager)

Name: Sign

Comments:

Regd. Office: Elegant Marine Services Private Limited: 401/A, Elegant Business Park, Off Andheri
Kurla Road, Near Kohinoor Continental Hotel, Andheri (E), Mumbai - 400 059. India
E-mail seacareer@elegantship.com, Tel: (+91 22) 3090 6100 Fax: (+91 22) 3090 6200
e
e

Liaison Offices: GURGAON: Tel. (0124) 4690400 / KOLKATA: Tel: (033) 40566100 /
KOCHI: Tel: (0484) 4063666 / CHENNAI: Tel. (044) 22504730 /
VIZAG: Tel (0891) 2749775 / PATNA: Tel. (0612) 2206788
LUCKNOW: Tel. (0522) 4024685 / CHANDIGARH: Tel. (0172) 4751200
JAIPUR : Tel (141) 4005091

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