\MINATI “AFARER BY AN APPROVED MEDICAL EXAI R. chant (Medical Examination ) Rules 2000 and ISM / STCW code 1/9 and ILO covention 147, ‘Accreditation No : South Agia ¥ DRAM. BALASL BALAJI MEDICAL CENTRE N.NA,ONN. 18, AGADEESWARAN ST, T.NAGAR, CHENNAI-600017. Ph ; 044-24364651,52,53 E-mail : dr @abaljimedicalcentre.com info@balajimedicalcentre.com Name: VJAYARANGAN __SIVASANKARALINGAM Sex M_ SetialNo: 61395 rane rire ane aa Date of Birth: 5/5/1982 ppicoc. 25545822 Rank: IRATALS Vessel Type Route: Home Address: 30, CHENGAM RD 1ST, TIRUVANNAMALAl-606601. INDIA Company Name “GAPE EAST LTD.DOHA-QATAR, [Medical Histo’ Please answer the following to the best of your knowledge Ee Conde] tamer rere any past /presea history of any eced a of the followivg Yay he Lye Ne Yer] No] Yes] Bi Hernia Rcrocodle [Aonencicis [Hi Heart dea t ae As $ i tems (les, etc) Alea sin seas d aed Z |“ Iofecton / Contanious disease z i Z Z Tobacco 7 iz d r 7 Major [Mine Operation ; Za i Z. BT Sioned off on medical rounds 7 Decared unfit 7 fal Examination: [wean Kas] Resahaie/mn 7 104KGS a7IMT GOOD cael Fad OF Vaslon ——[ atlomatry [7a] 500 TTR] 1500 Pepe tis : ama i 70[z5- | 35 mst] 20 ei : Abroad cao ele el Tae Tara ‘tama —T Hest Lea Rinht Ear RAL saat 2 err T eft eae RORMAT ORWAT proka arninaticrinaon wad Amer | or Notes te Se ee Te a Z Condon tkly tobe aggravated by sevice [Paranda ‘ St sea or to render the seafarers unit for | Cones aan Sem Such service orto endanger the heal of [er other parsons onboard? YES. es [EE fatae Vane investigation lormal [r eUdaen 1 [amos ee Taira roa x OS Terme — tar in fi i rere ta fi a0 Nit Teoh Mit tt ae VE ie ona ai eapuscers | Spirometry_NORMAL eee Drugs of NEGATIVE Abuse. Sofay Chest NORMAL STUDY. USG NOT DONE Result of Medical Examination = On the Jas ofthe examine’ sir, Gcal eamnaton and Gagnosic tes, I, DrAH. BAIA, hereby dadare the examinee rit ant CJ. Temporary Unfit [Permanent Unit] Should be reexamined in 7 weeks / months. Remarks/Reconimendation: KNOWN SMOKER FOR 2 YEARS .ADVISED TO QUIT SMOKING. TDr-AH BALAI , carly Wat all information required under Aynexiree &F of MS. (Medical Examination) RUS in is cortiicate bey: ‘This Certificate valid til 04/03/2022 A Reg. No. 56217 aa): Candidate's Signature Offcipt Stamp eH 6 TR Si“ Date: 5-Mar-20:Annexure -IV Medical Certificate for Service at Sea [Issued under the Authority of Directorate General of Shipping, Govt. of India under Rule 4 of M.S. (Medical Examination) Rules,2000 as amended] VIJAYARANGAN SIVASANKARALINGAM, (Seafarer Name: Last, First, Middle) Qsmsiieae aM Date of Birth: (ddsmmiyyyy) Gender: (Male/Female) Indian Passport/ CDC No__25545822 Valid until _anaranz9 hhas been examined by _DR. A.H.BALAJI TNICH/13/2016 (Name of Medical Examiner and approval no.) ‘and has been found fitfanfi* for service at sea in the job of IRATA-L3 Ii Unfiy Temp Unfit, Specify Reason. {@) The hearing and sight of the seafarer concerned, and the colour vision in the case of a seafarer to bbe employed in capacities where fitness for the work to be performed is liable to be affected by ‘defective colour vision, are all satisfactory; and (©) The seafarer concerned is not suffering from any medical condition likely to be aggravated by service at sea or to render the seafarer unfit for such service or to endanger the health of other persons on board. (6) The seafarer complies with the requirements specified in Table A-V/9 of STCW Code (ie. Minimum, in service eyesight standards for seafarers), Table B-U9 of the STCW Code (Le. Assessment of minimum entry level and in-service physical abilties for seafarers) and Regulatiog'y.2, Standard A-1.2 ‘&Guideline B- 1.2 of the Maritime Labour Convention 2006. 05/03/2020 & CHENNAI Dr. A. A. BALAJI (Date & Place of Medical Examination) (Siague TS MeO n016 50180 (Gerial number of the Certificate) —»«Address--NNA4(0N18JAGADEESWARAN ST. TNAGAR.OH-17 E-mail ID info@balajimedicalcentre com Contact no.- 9841026719 BALAJ! MEDICAL CENTRE ius pee on®04og2022 omc gs ie SRR (¢ Not more than 2 years from the date of issue, unless the seafarers is under the age of 18, inwhich case ~ thernaximum period of valty of the Medical Certificate shall be 1 year) Ifthe period of valty of the medical Ccertiicate expres in the course of voyage, then the medical certifcateshall continue to be in force for a period not ‘exceeding three months from the date of expiry, or untl the nextport of call where an approved Medical Examiner is available, and the seafarer can get examined and obtainrenewed medical certificate from that Medical Examiner.Medical Screening Questionnaire and Examination Record (cont'd) a arn i SF (Please circle and elaborate) 1. Chest pain/heart pain: Yes | No 2. High blood pressure/stroke Yes | No 3. Asthma/epdepsy/diabetes: Yes | No “apcuwanee ‘a mh 5, Kidney disease (eg stones) Yes | No 6. Psychiatric disorder (eg anxiety, depression) ‘Yes | No aaa wie 8, Cancer ‘Yes | No Do any of your immediate family (parents/brothers/sisters) have a history of any of the above conditions? Please specify: Do you currently have any of the following? 1. Backacheljoint of muscular pain Yeu | No [7 2. Hemiairupture Yes | No 3. Visual impairment Yes | No. 4, Perforated eardrum/discharge from ear Yes | No 5. Recurrent indigestion ‘Yes | No. 6, Jaundice/epatitis/gall bladder disease ‘Yes | No. 7. Change in bowel habilidiarrhoea Yes 8. Blood in stools/piles/haemorrhoids Yes | No 9. Shortness of breath/coughing up blood Yes | No. 10. Recurrent bronchitis/pneumonia Yes | No Yes | No. 12. Headaches/migraine/dizziness Yes | No. Berner v Nown Sr cleen Lov a ae Ael vised We Gut 83m oles certify that the above information is correct: disap ESSAMedical Screening Questionnaire and Examination Record (cont'd) Medical Examination To be completed by Examining Physician Photographic 1D: | Passport number: 2 t VieCA SPL Driver's licence number: Other: FEVy Urinalysis Height | Weight | BMI | BP | Pulse | FEV, | FVC FvC | protein | Blood | Glucose etait we 4! oP f wl fait fare | we’ Vision - Distance Vision - Near Colour vou L | Aided L Both L | Aided L Both ‘Normal ‘Abnormal i iL eae ‘Aided R R | Aided R | N A ‘Comment ‘Audiometric Screening ‘Substance Abuse Screening eZ ‘Stool Culture (Catering Crew) 7 nof Don?An ISO 9001 : 2015 Accredited Organization 1 into@balajimedicalcentre com, dr@balajimedicalcentre.com CHENNAI : Old Wo.18, New No.4, Jagadeeswaran Street, Nagar, Chenna-600 017. INDIA @) : +81 044-2436 4651 /52/53 'No.38, Manikodi Srinivasan Nagar Main Road, Rajiv Gandhi Salai, Perungudi, Chennai-600 096, INDIA. @): +91 044-2986 5513 /14 t No.51, Door Ho.20/10, Roche Colony, South Beach Road, Tuticorin - 628 O01. INDIA. ¢): +91 0461-2932719 / 20 }0a6, Ernakulam North, Kochi - 682 018. INDIA. @): +91 0484-2395006 / 07 / 08, VIZAG + Door Wo.39-11- 63/4-1, Murali Nagar, Visakhapatnam, Andhra Pradesh-530 007. INDIA. :+91 0891-2710299 / 399 MANGALORE : Shop No‘, Door No.1-65/31,Kulur-Kavoor, Airport Road, Vivek Nagar, Panjimogaru, Mangalore-575 013. INDIA @) : 0824-2972719 / 20 MEDICAL CERTIFICATE OF FITNESS FOR OFFSHORE WORK (Issued in accordance with Oil and Gas UK Guidelines) NAME: MR. SIVASANKARALINGAM VIJAYARANGAN DATE OF BIRTH: 05/05/1982 EMPLOYING CAPE EAST LTD-DOHA-QATAR. COMPANY NAME: OCCUPATION: TRATALS This individual has been examined in accordance with Oil & Gas UK Guidelines and is Medically Fit for Unrestricted Offshore Work. EXAMINING DR. AH. BALAJI PHYSICIAN NAME: OIL & GAS UKPIN | OGUK/2008/1266 NO: DATE OF ‘0570572020 EXAMINATION, DATE OF EXPIRY _ | 04/03/2022 OF CERTIFICATE: SIGNED: Dr.A.H. BALAST Reg-No--5621 {DGS Approval No.: TNICH/13/20160 ® Occupat IN No, OGUK / 2008 / 1266, “HEALTHIER MARINERS TOWARDS A WEALTHIER NATION”‘An ISO 9001 : 2015 Accredited Organization (8: info@balajimedicalcentre com, dr@batajimedicaicentre com mal-600 017. INDIA @ +91 044-2496 4851 92/59 al, Perungud, Chennal-600 096. NDIA, £): +91 442986 9513/14 TUTICORIN : Piet No.51, Door No.20/10, Roche Colony, South Beach Road, Tuticorin. 001, INDIA, @) : +91 0461-2332719 / 20 KOCH! 42/1008, O14 Raitway Station Road, Ernakulam North, Kochi - 682018 INDIA. © : +91 0494-2395006 / 07 / 08 Waa ‘Wo.99-11- 69/4-1, Murall Nagar, Visakhapatnam, Andhra Pradesh590 007. INDIA, @:+91 0891-2710299 /399 MANGALORE : Shop No.8, Door No. 1.68/31, Kulur-Kavoor, Airport Road, Vivek Nagar, Panjimogaru, Mangalore-575 013. INDIA 4) 0824-2972719/ 20 LABORATORY REPORT REG.NO: 59180 Name : Mr.Sivasankaralingam Vijayarangan Date : oyoyao20 Age 2 37Yrs Sex: MALE RefBy _: DR.A.H.BALAJI, M.B.BS, FCIP, PGDPC, PGDHSC, COMPLETE BLOOD COUNT (CBC) ‘OBSERVED BIOLOGICAL INVESTIGATION VALUE UNIT REFERENCE INTERVAL. ERYTHROCYTE (RBC) COUNT 47 mill/cumm 4.7-6.0 HAEMOGLOBIN (Hb) 145 gm/dl 135-18 PCV (PACKED CELL VOLUME) 46.6 % 42-52 MCV (MEAN CORPUSCULAR VOLUME) 88.5 fl 78-100 (MCH (MEAN CORPUSCULAR HAEMOGLOBIN ) 285 pe 27-31 MCHC (MEAN CORPUSCULAR Hb CONCN.) 33.3 g/dl 32-36 RDW (RED CELL DISTRIBUTION WIDTH) 128 % 115-140 ‘TOTAL LEUCOCYTES (WBC) COUNT 7500 Cells /cu.mm 4000-10500 ABSOLUTE NEUTROPHILS COUNT 3998 /emm 2000-7000 ABSOLUTE LYMPHOCYTE COUNT 2903 /emm 1000-3000 ABSOLUTE MONOCYTE COUNT 413 /emm 200-1000 ABSOLUTE EOSINOPHIL COUNT 173 /omm 20-500 ABSOLUTE BASOPHIL COUNT 20 /emm 20-100 NEUTROPHILS 533 % 40-80 LYMPHOCYTES 38.7 % 20-40 MONOCYTES 5S % 2.0-10 EOSINOPHILS 23 % 16 BASOPHILS, 02 % 0-2 PLATELET COUNT 2.03 10°3/ul MPV (MEAN PLATELET VOLUME) 74 i PCT (PLATELET HAEMATOCRIT) 034 % Dr. A. H-BABAJI PDW (PLATELET DISTRIBUTION WIDTH) 10.8 % Reg h9-195217 DGS Approval No. TNCH/13/2016 “HEALTHIER MARINERS TOWARDS A WEALTHIER NATION”Balaji Medical Centre An ISO 9001 : 2015 Accredited Organization 0: info@balajimedicalcentre.com, dr@balajimedicaicentre com lew No.4, Jagadeeswaran Street, T.Nagar, Chennai-600 017. INDIA @) : +91 044-2496 4651 / 52/53 _ No38, Mandi Srinivasan Nagar Main Roa, Rajiv Gandhi Sala, Perungut, Chemna 600086 INDIA. +91 044-2086 5513/14 | JAIN : Plat N.51, Door No.20/10, Roche Colony, South Beach Road, Tuticorin - 628 001. INDIA. @): +91 0461-2332719 /20, + Wa42 / 1898, Old Railway Station Road, Ernakulam North, Kochi - 682 018. INDIA. @): +91 04 : Mr.Sivasankaralingam Vijayarangan Age : 37Yrs Sex: MALE Ref By : DR.A-H.BALAJL, M.B.BS, FCIP, PGDPC, PGDHSC, PGCIH ROUTINE EXAMINATION URINE INVESTIGATION OBSERVED | UNIT BIOLOGICAL VALUE REFERENCE INTERVAL GENERAL EXAMINATION; COLOUR PALE YELLOW PALE YELLOW APPEARANCE CLEAR CLEAR REACTION (pH) 65 45-8 SPECIFIC GRAVITY 1.025 1.010 - 1.030 ‘CHEMICAL EXAMINATION (AUTOMATED DIPSTICK METHOD): URINE PROTEIN(ALBUMIN) ‘ABSENT ‘ABSENT URINE GLUCOSE(SUGAR) ABSENT ABSENT URINE KETONES(ACETONE) ‘ABSENT ABSENT BILE SALTS ‘ABSENT ABSENT BILE PIGMENTS ABSENT ABSENT UROBILINOGEN NORMAL. NORMAL NITRITE NEGATIVE NEGATIVE MICROSCOPIC EXAMINATION RED BLOOD CELLS NIL 7opf [0-2 PUS CELLS (WBCs) 12 /opt | 0-5 EPITHELIAL CELLS 3-4 /apf | 0-5 CRYSTALS ABSENT | /hpf | ABSENT CAST ABSENT | /hpf | ABSENT. | AMORPHOUS DEPOSITS ABSENT | /hpf | ABSENT BACTERIA ABSENT | /hpf | ABSENT Reg. No. £6217 GS Approval No: TN/CH/13/2016 “HEALTHIER MARINERS TOWARDS A WEALTHIER NATION”