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MINISTRY OF SHIPPING
MMD DELHI
Application for GMDSS
GMDSS/MMD(DL)/2019/6362
GMDSS Certificate No. : 0003791
GMDSS Cert. Valid Till : 29-OCT-2019
GMDSS Cert. Issue Date : 05-JUN-2015
Name of the Doctor : DR. RANBIR SINGH DGS Approval No. for : MAH/MUM/63/2015
Port of Registry : MONROVIA Rank Served : Watch Keeping Deck Officer OINW or Third officer
Port of Registry : MONROVIA Rank Served : Watch Keeping Deck Officer OINW or Third officer
Port of Registry : MONROVIA Rank Served : Watch Keeping Deck Officer OINW or Third officer
Attached Documents
Sr. No. Documents to be uploaded
4 Recored of One Year Sea service in Original letter issued by the Vessel Owner / Agent with RPSL No. & e-Mail address
6 Self attested scan copy of Medical Fitness Certificate from DGS Approved Doctor
7 Self attested scanned copy of CDC booklet pages showing relevent sea services.
Declaration
I hereby declare that all the statements made in this application are true and complete to the best of my knowledge and belief and
nothing has been concealed/distorted.
I Agree.
Place : Signature of the Applicant :..................................................
GMDSS/MMD(DL)/2019/6362
...............................
Date : 08-APR-2019 Name of the Applicant : UTKARSH MATHUR