Seafarer'S Application Form
ADVERTISEMENT
1
2
3
4
5Darya Shipmanagement Pvt Ltd.
FORM : PER -1
.
SEAFARER’S APPLICATION FORM
RANK APPLIED
DATE OF APPLICATION
INDOS NUMBER
DATE OF AVAILABILITY
1. PERSONAL DETAILS
SURMAME
FIRST NAME
MIDDLE NAME
NAME
Date of Birth
Place of Birth
Nationality
Permanent
Present Address
Address
City & Pin Code
:
City & Pin Code
:
Telephone
:
E-MAIL
:
2. NEXT OF KIN / FAMILY PARTICULARS
NAME / RELATION
ADDRESS
NAME
D.O.B
PP/NO.
ISSUED/VALIDITY
WIFE
:
CHILD (M/F) :
CHILD (M/F) :
3. PASSPORT DETAILS
NUMBER
PLACE OF ISSUE
DATE OF ISSUE
DATE OF EXPIRY
PASSPORT
US C1/D VISA
ECNR
4. CONTINUOUS DISCHARGE CERTIFICATES(S)
CDC
NUMBER
PLACE OF ISSUE
DATE OF ISSUE
DATE OF EXPIRY
INDIAN
LIBERIAN
OTHERS
5. ACADEMIC QUALIFICATIONS
Grade / Degree
From (Year)
To (Year)
SCHOOL
COLLEGE
PRE- SEA TRAINING
INSTITUTE
Version No: 01
Dated: 01-Jan-2015
Page 1 of 5
Approved by : CEO
CONTROLLED DOCUMENT
File: Office
Frequency: During Crew Selection
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Mi-273 - Application For Seafarer's Identification And Record Book And Special Qualifications
Business
Application Form For Seafarers In Transit-underthe Danish Transfer System (visa Exemptionfor Seafarers)
Business
Related Categories
Parent category: Business