Sanat naam Se ane pam | i sat Se et = eer| or eee ween] nmae mace co en rae one fateaeiubemre oer mama e Hee eee rat vonn na ‘ONLINE IxSpeon or ASSESGMENT hepa’ Menor Oned a4 patted eae i He ee "8022020 |) CANDIDATE WHO HAD DONE MANUAL BOOKING FOR WRITTEN / ORAL FROM [CanDibate wio HAD DONE MANUAL BOOKING FOR WRITTEN] ORK: POM JFRIOAY TO | 21022020 TO layer CLASS 1, MEO CLASS II PART'A' fy! te ETO. Pe are aaa eae Se tect macs ogi onemaeena am eS een nese nears ) Sa ean. Waco CL wvPon sch CLW Por 8 he conse hs iene Opi on oT RSTS The rsa le HES COASS TV PRAT wad oa Ta REED re na see eeecreenme ieee are fos mt eres SengeSAMPLE (USE ONLY BLACK POINT PEN) ey (CcapiraL LETTER ONLY’ = FORM 20 teeta?) GOVERNMENT OF INDIA MINISTRY OF SURFACE TRANSPORT DIRECTORATE GENERAL OF SHIPPING Applicaton for Examination and Assessment for certficaes under Merchant ‘Shipping Standards of Training, Cerifiction and Watch-keeping for Seafarers) Rules, 2014 for manning ships in foreign-going and Near-Coastal Voyages trade Application No. gE. Po kha 4 Received Date: J20__ A Grade of meOcL W PROTO SanmaonPuct ao AUARAT. oo. Examination (Formals) 1 ee UNV SAGAR GUPTA 2. Permanent Address VILL TAROWA, P-O- GqURVA, 2S - GIURVA ‘DIST GAYA, RE WAR-S2420¢° ees SAME 45 ApoE oR o7eR 1 cwanineD AE. wnrswoeesey 2346090315 Sater proaucey SW OTA 8. Passport. Number 7. Date ane Pace of esve 8. Coninuous Dscharge Genieate (CC) Nomber 8. Date and Pace of asve Pfpetiotepoties) “oslo 948 11 Peoeo! Brn GuRDA 2Pesora mans A MOLE ON THE LEFT CHEEK 13. 1Noe No cone (Ataensecinong. fry MP) ‘Noe Any Peon who makes casas o Be made or agsiis“n sting any le representation tbe purpose obtain ohne) hrs’ any ob becon 8 Crista, sl belo fo poateuton unde Sector Ted & #20 he nda eral Cade 1980,‘Application No, ¢ Received Date 2 Principal Subjects 2 Year o Passing ‘4 Senoaicaege! Board 5 Adress ofthe Inston (DETAILS OF PRE-SEA TRAINING / MARINE ENGINEERING WORKSHOP 7 (Separate sheet must be atached) {Training nstute Mabaswstion Acadeny a) Arve) Fducabion © Training 2 Racers ftetnenaion “SN0. 124 Paud Road), Kolhaud, MET Contd, 411 039 Fmd. Conky eerste aipalzees To a frlene 4 Rost a ‘5 Courses Atended B.Tech Matine /GME (Hs applrcerle) ‘REQUEST FOR ALLOTMENT OF SEAT FOR EXAMINATION CPpument debate) Level Signature ot Meer’ anoint te Racin. Fron Onwatona Sune! | Eran ae center cara MEPL |slosiroooiayfee WA, | enor 3000 /- Pager’ sestrmensferearriet | Batlaen mmnlp [3000 | pate reg! O | Biase _ REPORT ON STRUCTURED ON-BOARD TRAINING (OMEIATS{OTHERS) + | Bee orconpeten oy | Naeot Dada rakira ORS | oui Cente OfCampsiney Page 2of 11‘Application No. Received Date (Copy of Training instutlOtee Report io be Fumished) ‘PHASE 1 As Apprentice Engineer Ofcer PHASE 2 -As Traine Engineer Officer PHASE 3. AS Engineer Ofer hong Class VCO PHASE 4. As EngeerOficerholing Cassi! COC F. DETAILS OF SEAGGOING SERVICE (FOR ENGINE DEPARTMENT PERSONNEL) q il aaa Docecoen | E) EI os cers loss WEE He) Fm 1 op Taam ati | GB bar wwer peemary wus Fey “IME vce) Vadonig | Tota Arie Pevaa [Sd Towass:[ Nol: Stte whether performed LI,LN.V.V |. On fters Work, ether by day o on watches on Deck erin Engine and Bode Reams 1 On requar watch on alias oretigeraton and ar condoning machinery 1 On rogue watch - 0a main engines 1¥. On regular watch -on main bles On reguar watch on both main engines an bolls simutaneousy, Vn shigs,partaty ofl unmanned machinery space. ‘Tre use of appropiate Roman numbers willbe suient for IN.V ana + QS -Cuaiying Sea Service (Propeling Time Calculated at 30 Days 2 Month) “FG (Forign ging), CV (Coastal Voyage) or INS\Indian Naval Service) or CG(Coas! Guard)‘Application No. Received Date _/_/20_ {G. PARTICULARS OF STOW CONVENTIONS MODULAR COURSES & courses STV Cate owt No 1 SR [acme \ebebooe ystolroie [2 Mimamemes” — amlral WW lap.maine — |aclsleete anlaborst > fmememsranery ahs | lapmarite — palateots asishoe «Ramones nals WE lee, maeine pMaboe|asishoie CS GRROAENT hale) fF lep.maerie —taroig, whole) | [6 SAM ERRERORTIG asa] BPMARINE —pslnlzelqaatbeaq | ae Se uP MARINE —_/lilaese | a slseze Bae, PSS | WR Teemnarte lett |-visens Bree codes | Page $f‘Application No. Received Date _/_/20__ H. Level Apps for OPERATIONAL / MANAGEMENT LEVEL (Tick ./the appropto Function) ‘ee Funcom legac 3 [a aT aM AW] AV] AM] wo ‘Cendaate =a ee |e eee le roo ea al al (a ene in| wv [— [— | — a fu | |e ete |L PREVIOUS CERTIFICATE (Issued in India o elsewhere, none state $0) conte Pec ddawct | Wanye sponded oF acne memeer| Cie Castors | examnaten | tive SRE oate | cane sory 4 DECLARATION TO BE MADE BY THE CANDIDATE | nereby declare that th parulrs contained in the form te covtect ard tue to the Bes of my knowledge nd ballet ‘and that he papers enumerated and sent win ti form are rue and genome cociments given a signed by parson whose name appears on tem | urther deca that Secon F canta @ Yue and cvect account of my sea-glng Secs Witnot exception and mare thi decleraton consclentoualy bevovng the same tobe Wve ftodu 5. uch, ‘The above declaration was signed in my presence, Birdie | Slanatuge of he canccate Examine of Masters and MatbsfEngineers Offcars = Mercante Marne Deparimert MUMBA... Dstrct k. POST:SEA APPROVED EDUCATION AND TRAINING AT APPROVED INSTITUTION LEVEL (Preparatory, Voeatora and Up gradation Courses) Page sofa‘Appication No. Received Date _/_/20_ Remaris Funeton Part Inston From Te ‘Statng Grates in Assessment Massa MARTI E ileal eos ERs 2oAouaggata-1810 ACADEMY, \L REPORT OF HEAD OF ASSESSMENT CENTRE: (Preparatory, Vocational & Upgradation Courses) (Gardai Periomance enh and weskess any mut be clay sta es, Repo card designe yrs and in ‘rdonce wih DOS arecves ust be atache, Coa esing ras in oe of peromance achieved) Soratue Neve Offical stamp: i Fa peop iy Cee th Dl ons 0 pol as ms ange ao) 1M. REPORT OF HEAD OF ASSESSMENT IN EXAMINATION SECTION Documents in Order Yes Proforma for WiShop Training Checked and Tales YesINo Photos Enclosed YeuNo TAR Book duly Completed and Endorsed YesiNo Fees Receved Yeune GICEW Book Duy Completed and Endorses Yet Candidates Elbity fo Functon | Grade of Examination assessed and inorder N. EXEMPTION -Exanpion any Oot Rule for NETA Manual I or Spas DGS eeenceBignature of Examiner of Engineer deat ne enero gee ‘©. REMARK OF EXAMINER OF ENGINEERS ASSESSMENT INOROER _YeaNo ELIGIBILITY FOR OPERATIONAL LEVEL / MANAGEMENT LEVEL EXAMINATION Ege For writen 30 4A CAMO AAI AO AAV O48 SO 8 ElgtieForOralFuncton 3.0) 40 80 60 CCanedate Found neligile Ard Duly Informed You No (Use Form IN) Sonne Nae OFFICIAL STAMP, Page 603ApplicationNo, § Received Date Instructions 1 2 All entries must be made by the Candidate in his own handwriting except those for official use, which are Sided grey. 5. Grades of Examination (Page 1) MEO (Main Steam) ~ Class 1V, Class Il, Cass 1 Nev = Class IV, Class il SEO, Class TI CEO 4. Candidate must refer to is EXN-45 and META Manual I & I, to assess his own eligibility for the relevant ‘courses / Exams before filling in this form. 5. Details of Name, Date of Birth Ete. must be as per the ‘changed by legal means 6. Candidate must produce the originals for verifications at every MMD. Verification of Certificate may be resorted to by MMD if required 7. Two additional Passport Size Photographs with the signature on backside is to be submitted along with application Form in a small Envelope for attachment with DGS final register. 1, Sea time certifieates must be dual endorsed by ether Indian Embassy, Consulate abroad, Flog state officials of flag of vesset or any other organization approved by the Directorate 9, Entries in F must be made foreach phase, giving date of completion asthe date of discharge from ship. Name of tcuining officer isthe shipbosed or company designated officer. Details of certificate of competency are the ‘current certificate which the candidate holds. Attach separate sheets fr additional enti. 10, Entries in Part ~T whic includes sections A, B,C, D,E,F, G, HL, Jar to be made by the candidates. 11 Entries in Pat I which ineludes setions K,L, M,N, and O are for official purpose only. 12. Entries in Part ~ Ils exclusively for oficial purpose only ©, HSC, Board of Examination Certificates unless Details of Functions 5 ~ Controlling the operation ofthe ship & care for persons onboard at operational and management level. 4A Part A Marine Engineering at Operational level and management level, I~ Heat Engines 11 — Applied mechanics IV — Engineering Drawing V ~ “Mechanics & Hydzomechanics VI - Thermometer and Heat Transfer. {4B - Part B Marine Engineering at Operational level and management level 5. = Electrical, Electonics & Control Engineering at Operational and Management level, {6 = Maintenance and repair at Operational and Management level. Page Pol tt‘Application No. Received Date © _/_/20_ Proforma @ Part tt Dake ree a Forofce se Only Dos Ref. DOS Fin Content Na, LATEST PHOTO ManeofCandise: BINDY SAWAR GUFTA (69%35) Permanent Ades: Groen) aco Bit sa) Pls fin ous 94018 ram Conar: VOB Sie MAR ARASITES RowiooNa: E-patkha td pen asno safer 20279 exam Date: (fae me) ‘A. Level Aol for OPERAT ONAL MANAGEMENT ate FUNCTION eae 3 RT RN A RAT we rye ue esas Mex] MEK | MEK we rlu cones | No | aus |2. writen Funeton Passed OPERATIONAL / MANAGEMENT Love = Tea Sig of Bearing [ae FR RW AW AT e [8 |W Tas) Inexie] wex | mex we | MSE | aes op cio Waxt Page 8 ofApplication No. Receved Date _/_/20_ ‘© Orals Function Pasiod OPERATIONAL / MANAGEMENT Level Date FUNCTION ‘Signof Functions | ___Function 4 Funaioné | Fureton | —SCSCS* er coscen | medioe | me mm | mer | mR NERT mort YEAR Dota of Functions Witten Papers '3-Contoling theopeation of the ship and care fr persons onboard at operatonal and maragernent evel NA.- Naval érhtecture, SS and EP - Ship Safely and Envronmenal Protection and Personnel are 48. Patt A Marine Engineering at Operatona vel and management evel, Mi: Mecnanes and Hydromecnanies, TT - Thermodynamics and Heat ranemision ~~ &B Pan & Marne Engineenng at Operatoral level and management eel Page deftApplication No. Received Date : _/_/20_ For MEO CLASS II-HLE K (Sm COM) - Marne Engineering Knowledge (Steam), ME.K (G)-Marne Engineering Krowedge (General) ME K (WSISm)-Marne Engineering Knowiedge (Moker) '5- Electrical, Electronic & Contol Engineering at Operatonal an Management ve MET - Manne Elect Tecnology (6 - Maintenance and par at Operational and Management evel MED. -Marine Engineering Pracico 3 of Functions : Oral Papers "3 COSCPN - Contoling the operation ofthe Ship and Care or parsons onboard |4- MLE (Mote Marne Engineering Motor), ME (Stam) rine Engineering (Stam) 5-MET. - Electeal, electronic and contol engineering 6- MR - Mainenance and Repair . Examine of Engineers Final Assessment Prior Reconmendato for Cerifeation Requirements aus Requirements satus Medical Finess Yes/No | Preparatory and Up gradation Yes/No Pre Sea Tianna YesiNo | Otners (Sate couse) Yes No structured on Boars Trang ‘Yes/No | Wien Examinaton Yes No Sea Service Requrement Yes/No | Oral (Assessment) Yes No IModutar Courses Yes/No | Egy Yes No "Fore Chit Examiner of Etahoor OFS tery ceray that torn 1es__/_ Ins setafciiy preted testinal and prot ut Sea-gong SeneeWaich Keopng Serie. 2, Tho candidate complies vt the requlements of the Merchant Shipping (Standards of Trinng Cerifcaton and Witch- keeping for Seafarers) Rules, 1008 for tbe grade of Under STW Reg, 5 The candidate has passed his examinations fo tig Tuneians a under axe s0 044‘Application No. Received Date _/_20_ Fancton ‘amination Coe Monb¥ear Remarks "Tis candid etl he egrets & eligi fr ete Corin of Company as “Tb eine of opts yb forwarded othe Merete Morne Deparment fr ssn, (Sigranre) ‘amine of Engines Mecaile Marine cenit of Competency fr grade with tation recommended by Imereti marine parent may be aed REMARKS (Spell Conon any) Initia of Assen at DOS ess of Functions: 2 -Conoling the Operatn ofthe Ship & Care foe Psa on os at Operational and Management Level {Aart 8 Marine Eginecing a Operational Leve and Management Level {Hea Engines l- Apps mechan Il- ethers IV Engocetiag Drawing V- Mechanic & Hycromechanics Vi- Theenogyanies and Hea Transfer 48 Par 8 Marine Engineting at Operational Level and Management Level 5 Ele lesan Contol Engineering ot Operational nd Manapement Level 6“ Maitnance and Repu st Operational nl Managemen Level (A) Onthe cane pasting ll fans «grade and on sary evaluation by Examiner of Engineers, the DOS Fina ‘Regier daly completed ist beset be DOS Comat Tor every Hom Appian Fo ee abe sea DUS. (8) The shes shoul be prefeahly computer Gerard nd Recorded {(C)Acopy of the shat soul be teaned athe especve MM Pro dispatched o DGS as hard copy Candies Specimen Sigratires (To be uly sgned inl or boxes tthe tne of ubmson of fue] Bincla Orn 2 “Carre w DGS for Pasting on COC Banda Bindu Page 11 of 1