Form: OPR-01

RIGEL MARINE SERVICES (P) LTD. Issue No.: 01

(Lic. No. RPSL MUM-229) Date of Issue: 01.04.2013
Rev No./Date: 01/01.09.2015

OPR-01

BIODATA / PRE JOINING FORM - OFFICERS

PERSONAL DATA
Surname Middle Name First Name
KASHYAP `KISHAN
Nationality Date of Birth Place of Birth
INDIAN 24-12-1992 PACHOMI,U.P
Post Applied For Willing to Accept Lower Rank ? Available From:
3RD OFFICER Yes / No YES(JUNIOR OFFICER)
04-08-2017
Permanent Address: Present Address:
C/O Ganga Prasad Kashyap, DHANISHTA 10-B,NEAR K.V NO.3,
Vill & Post -Pachomi, Teh- Faridpur, Dist- Bareilly R.C CHURCH, COLABA
U.P-243503
Post Code:400005
Phone: STD Code: No: Phone: STD Code: No:
Email:kishan_kashyap@hotmail.com Mobile No: 9762430609

Passport No: Date of Issue Place of Issue Date of Expiry ECNR Blank Pages
J3929452 10/12/2010 THANE 09/12/2020 Yes/No Yes/NoYES

MUI Membership
No:

Seamans Book (CDC) Number Date of Issue Place of Issue Expiry Date Remark
Indian MUM- 22/05/2017 MUMBAI 21/05/2027
188497
Liberian
Panamanian
INDOS No : 10NL2940
Others

Licence Grade Number Date of Issue Place of Issue Date of Expiry

Indian 2ND MATE F.G IF-33511 07/12/2015 MUMBAI 12/10/2020
U.K.
Liberian
Panamanian
Others

Civil Status: Single/ Married/ Separated/ Divorced/ Widowed SINGLE

Full Name of Next of Kin: BABU RAM Relationship: FATHER
Address of Next of Kin: DHANISHTA 10-B,NEAR K.V NO.3,R.C CHURCH, COLABA, MUMBAI-400005
Phone-STD Code: No.:9082238951
 Form: OPR-01
RIGEL MARINE SERVICES (P) LTD. Issue No.: 01
(Lic. No. RPSL MUM-229) Date of Issue: 01.04.2013
Rev No./Date: 01/01.09.2015

Family Data Name D.O.B PPT.No. D.O.I Place of Issue D.O.E ECNR

Wife
Child M/F
Child M/F
Child M/F
Child M/F
* Tick Valid Visa USA UK Australia

Details of Courses & Certificates Number Date of Issue Date of Expiry Issued by
Advanced / Basic Fire Fighting AFF REF 09/12/2014 08/12/2019 T.S CHANAKYA
524/2014
Proficiency in Survival Craft / Rescue Boat / PST 150291 04/02/2015 03/02/2020 B.P MARINE
ACADEMY
Elementary / Medical First Aid /Medicare SMI/RMFA/87 27/01/2015 27/01/2020 S.N.S MARITIME
ACADEMY
2/2015
Personal Survival & Social Responsibility (PSSR) BPMA/PSSR/3 17/12/2014 B.P MARINE
ACADEMY
010/2014
Radar Observer / ARPA B8E4BD7767 28/12/2013 27/12/2018 NAVAL
MARITIME
D6430 ACADEMY
Radar Simulator (RANSCO) / ENS
Ship Handling Simulator
LCHS
GMDSS / MCC M/GOC/15/33 09/11/2015 21/11/2023 NAVAL
MARITIME
51 ACADEMY
Petroleum Tanker Safety (STPOTO)
Chemical Tanker Safety (CHEMCO) YAK/CHEMC 17.12.2015 YAK MARITIME
ACADEMY
O/12/012/01/1
5
Gas Tanker Safety (GASCO)
Oil Tanker Familiarisation (OTFC)
Chemical Tanker Familiarisation (CTFC)
Gas Familiarisation (GTFC)
Ship Simulator
Engine Room Simulator
Hazmat Course
Bridge Team Management BTM/10/2016 30/01/2016 29/01/2021 A.I.M.S
Revalidation Course
COE (Singapore)
Yellow Fever 04784 28/07/2011 27/07/2021
Others
TASCO YAK/TASCO/ 03/12/2015 YAK MARITIME
ACADEMY
11/010/05/15

Dangerous Cargo Endorsements Grade/ Level Number Date of Issue Place of Issue D.O.E
I / II
Oil I DCN01 06/05/2016 MUMBAI 05/05/2021
MUM16
000535
Chemical I DCN01 06/05/2016 MUMBAI 05/05/2021
MUM16
000536
Liquified Gas
 Form: OPR-01
RIGEL MARINE SERVICES (P) LTD. Issue No.: 01
(Lic. No. RPSL MUM-229) Date of Issue: 01.04.2013
Rev No./Date: 01/01.09.2015

Pre Sea Training / Apprentice ship

Name of Institute / College From To Type of Degree
YAK MARITIME ACADEMY 01/08/2010 30/07/2011 DIPLOMA IN NAUTICAL SCIENCE
 Form: OPR-01
RIGEL MARINE SERVICES (P) LTD. Issue No.: 01
(Lic. No. RPSL MUM-229) Date of Issue: 01.04.2013
Rev No./Date: 01/01.09.2015

Previous Sea Service (Date Commencing from Last Vessel)

Sr.No. Name of Owners / Manager Name of Vessel Type DWT BHP Engine type UMS Rank From To Total Reason for S/OFF
Y/N MM/DD
1 EAST INDIA SHIPPING M.V JUMBO RO- 1647 2400 N DECK 20-03- 26-09- 18/07 COMPLETION
AGENCY EXPRESS RO CADE 2012 2013 OF TERM
T
2 S.KENGINEERING M.T SPICA OIL 46168 10440 N 3RD/O 30-07- 30-01- 06 COMPLETION
SHIPPING TAN FF 2016 2017 OF CONTRACT
KER
3

10

11

12
 Form: OPR-01
Issue No.: 01
RIGEL MARINE SERVICES (P) LTD. Date of Issue: 01.04.2013Issue No.: 01
Rev No./Date: 01/01.09.2015
(Lic. No. RPSL MUM-229) Date of Issue: 01.04.2013
Rev No./Date: 00/Nil
Medical History
(a) Have you ever signed off from a ship due to Medical reasons, No
( If Yes give details)
Name of Vessels Date of Occurrence

Brief Description of Illness / Injury/ Accident

(b) Did you suffer or Are you Presently suffering from any Disease likely to render you NO
unfit for Service at Sea or likely to endanger the health of others on board.
(c) Are you addicted to alcohol or drugs of any kind. No
(d) Have you suffered from following
Malaria Diabetes Epilepsy Nervous Disability

(e) Did you ever undergo physhiatric treatment : No

Reference Checked( For Office use only)

Name of the company Address Yes No

Name of Person Title Phone No.

I hereby affirm that all this information provided by me in this application is true and correct to the best of my knowledge and belief; further,
that no Certificate of competency or Licence issued to me has ever been Revoked or Suspended. I also certify that my medical history
contained above is True and any false statement or undisclosed Material information about past illness or injury will disqualify me from any
employment benefits and claims.

Date__03-08-2017_________ Rank______3/OFF___________ Signature of Seaman ________________

(FOR OFFICE USE ONLY) INITIAL INTERVIEW (Tick as applicable)

Original licences sighted [ ] Checked [ ]
STCW and Training Certificates sighted [ ] Checked [ ]
Experience confirmed by interview Yes [ ] No [ ]
Other details confirmed by interview Yes [ ] No [ ]

Crew Managers assessment : 1st stage ______________________________________________________________

G. M.s assessment : 2nd stage ___________________________________________________________________

Accept [ ] Await Position [ ] Re-interview [ ] Reject [ ]

Suptd. / Gen Manager Signature: ________________ Date: ___________

Approved By General Manager Yes [ ] No [ ]

Approved By Head Office Yes [ ] No [ ] N/A [ ]