SEAMAN EMPLOYMENT APPLICATION FORM

Personal Particulars
First Name: IMRAN Middle Name: Last Name: KHAN
Name (as in Passport) IMRAN KHAN Date of Application
Position Applied For O/S Sex MALE Blood Group O+
Nationality BANGLADESHI Religion ISLAM Marital Status UNMARRIED
Date of Birth 30-03-1996 Height (cms) 5'-9" No of Children N/A
Age 23 YEARS Weight (kgs) 72 KGS. Hair Color & Eye Color BLACK BLACK
Place of Birth CHITTAGONG Education S.S.C. Birth Mark N/A
Name of Spouse SINGLE Employee No: N/A Nearest Intl. Airport SHAH AMANAT. CTG
Email ID: imrankhan201880@gmail.com Facebook ID: imranshabirimu LinkedIn ID:
Present Address Next of Kin - Name / Relationship / Address Alternative NOK - Name / Relationship / Address
SOUTH PATENGA, NAZIR PARA, M.A. GAFUR MEMBER SAME AS ABOVE
BARI, MODHYA PATENGA CHOWDHURYPARA
PATENGA, CHITTAGONG, BANGLADESH.
Home Telephone Home Telephone Mobile Phone 01811-654460

Travel Documents Type Number Date of Issue Date of Expiry Place of Issue
Seaman Book No. CDC T/33615 24-Aug-20 23-Aug-30 SHIPPING OFFICE
International Passport No. BANGLADESHI BH0916161 CHITTAGONG
U.S.A. Visa Type ( B1-B2 / R D / C1 / D )
Seafarer Identification Card (SID) SID 050012595 26-Aug-20 25-Aug-30 DG SHIPPING

National & Flag Licenses (STCW) Grade Number Date of Issue Date of Expiry Issuing Authority
BANGLADESHI RATING AS ABLE SEAFARER EN
BANGLADESHI ENG RATING WATCH KEEPING

STCW & Other Certificates Place of Issue Date of Issue Date of Expiry Issued By Number
FIRE PREVENTION AND FIRE FIGHTING COURS DHAKA 23-12-2018 20-10-2023 DG SHIPPING 040.084929
PERSONEL SURVIVAL TECHNIQUE DHAKA 23-12-2018 10.12.2023 DO 039.084931
PERSONEL SAFETY & SOCIAL RESPOSIBILITY DHAKA 23-12-2018 29-11-2023 DO 042.084930
TANKER FAMILIARIZATION - OIL & CHEMICAL DHAKA 23.12.2018 30.10.2023 DO 030.084927
ELEMENTARY FIRST AID DHAKA 23.12.2018 03.12.2023 DO 041.084928
PROFICIENCY IN SURVIVAL CRAFT & RB OTFRB DHAKA 23.12.2018 07.11.2023 DO 043.084932
ADVANCE FIRE FIGHTING
SECURITY AWARENESS TRAINING REG VI / 6-1 DHAKA 23.12.2018 22.10.2023 DO 049.084934
DESIGNATED SECURITY DUTIES DHAKA 23.12.2018 24.10.2023 DO 050.084933

Sea Service Career.

ONBOARD PERIOD TOTAL VESSEL MAIN ENGINE MAKE
NAME OF PRINCIPALS VESSEL'S NAME RANK DWT GRT
FROM TO M/D TYPE TYPE / BHP
A.K SHIPPING GROUP MV. OCEAN PRIDE 06.06.17 01.11.18 17 O/S 21941 BULK 9600

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