oo [CHENNAI : Ol e.18, ew Ho, degndesmarn Sis, Taper, Cheenn-60 017 INIA: #91 0442408 41/82/83 38 Maa Snr agra Ren Ra Bah Sa, Png Charan 60 OO DAD: +1 THB 1485 roc: we-at/ 1090 Rawoy Satin Reed, rata Worth, ach 602 O18 WIA. ): +1 444230808 07/08 WAG boo h-3-11- 63/41, Mural Hear, Veabapstaum, dada Pradesh S30 007. NDA. +81 OB-271208/ 208 MANGALORE: Sop. or Ha 435, Kat avo Nip Road, Ve Nap, Paimogna, Manalr 75 O31. NDIA: 0026272719 SPIROMETRY CHECKLIST Name SevTine Poo: Borne Reg.No. 5027S | Date: 8'12-01-h Age SY Height = )b4 Weight 73 DOB: yo 5-ABT cones OES sex Wi Fork: Rope Access 13 SvicRMHOR Occupational Medical History Exposure / Respiratory Hazards 1b Smoker: 1 yes (for...Years)/ How Many? fe) Other known lung diseases (asthma, COLD, TB...) ‘Question before Spo: ___ YES, spremety should not be done now! ‘Do you have any iness or condition which prevents you from exhaling forcefully ‘of taking a deep breath? (Postpone til condition is resolved) Have you smoked any cigrettes or bid within the last hour? (postpone for 1 hour!) Have you used any inhaled medication within the last hour? (postpone for 1 hour!) Have you eaten a big meal within the last hour? (postpone at least 1 hour) Have you had a severe cold, fu, bronchitis, severe coughing or bronchitis within the last three woeks? (postpone for three more weeks!) ‘Have you had any ear infections or other ear problems within the last three weeks? (postpone for three more weeks!) Sel SN |S] G1 Se te Evaluation by Techniciar Performance of Patient at Spiro ‘Three acceptable test completed ‘Comments on test quality and evaluation 3 sonar of Tecriian : OE SignatureFVC TEST REPORT Ne. sorry Pabent Name = iter, BoomOVAN ‘Agoies) >on Sex Wein: 73 | INTERPRETATION: Normal Spirometry | ‘This may be clinically co - relate, ‘SESLGRE GENESIS sakeBgoeabmecescom ~ BALAJI MEDICAL CENTRE ‘Report Date: z2e7a018 | Eth, Gor): 00 Heighemy 182 BSA} 209, CeErErererEret rma)‘An 180 9001 : 2008 Accredited Organization {: info@balajimedicalcentre.com, dr@balajimedicalcentre com (18, nor Me, auteraa Se ge Chana OH 7, NO.) 01 84 216485882 ‘kta rte tga an anh nanos OE a 4 EE URS ‘stam, au Snos Randa Worth oh DIA. +48 U6 300/678 Zz) Maer Vebaptnm, as Pre 50 07, MOR 094 08827820 / 299 MGHLINE: thy 4801 alr an: prt at Ve pease Magso7S 31. OIA 0242972718 AUDIOMETRY CHECK LIST Date :22-07. 3019 Name: genre foo Beard Reg.No: oon Nae/8e? Bu [mace DOB > 3)-03-1485 Company: OES, Rank: Rope Acess cover 3 SuPervisicr| History : = _ Did you have any hearing problems in the past Yes | No ‘or have you been treated for ear problems? o it yes, what problems? = Did you in the past or do you presently have ear infections or aches? ves | = Do you suffer from constant ear sounds (tinnitus) or vertigo? Yes | NO = Does hearing loss occur in your family? Yes | No Details v = Do you have dificuities understanding conversations ves | No = Are youhave exposed to excessive noise at your workplace? ves | ty = Doyou wear ear protection at your workplace? Yes | tp tyes, which kind? ‘Are they comfortable to wear? Yes | No = Today: Forhow many hours have you not been exposed to oud nose ours Further Details = Bdshe ~ Candidate SignatureBalaji Medical Contre >) 12: info@balajimesicalcentre.com, ér@balajimedicalcentre com CCHENWAL_: OM Wo.18, New No. Jagadeeswaran Stet, oqar,Chana-00 O17. NDIA © +91 44-2636 4651/82/53 N38, Mand Sivasan Hae Wain Rod, aj Candh Sal, Parangu, hena-00 O86, NDIA. 2): +91 044.2086 8813/14 TUTICORIN Peto. Dour No 2010, Roche Clon, South Bach vt Teter 628 01, MOA): +81 8841028719 Toc: Nott, Oe tay ston Rt, Cam rac 218 WD: Bt 8/7 /8 MAG: Dut. 044, rage engin te Pd 0, MO 9 OB 2798/28 IMCL: op sr 8 ao et a en, ui S796 Kn ET eens Nami: MRSENTHILBODIBOYAN 6) ate 20749 -- @ ie SF Tesvereres. e — Frauen ine [eecoleslerclseler fe orecoarron mr—lo | o lel s bw “Teng equpene Gap aot NORMAL AUDIOMETRY mons: PSDs 8) ‘Aroved by Broce Gna of Sheeng ‘Constr sss and eg. No 58217 “HEALTHIER MARINERS TOWARDS A WEALTHIER NATION”An 150 000215 rested Oganzaton [: info@balajimedicalcentre.com, dr@balalimedicalcentre.com Old Wo.18, New Mo. Jagadeeswaran Street, Taga, Cheana- #00017. NDIA @ : +91 044-2436 4651/32/33 "No3H Manoa Sinrasan Nagar Main Road, aj Gandhi Sl, Porengutl, Chenn-600 06, MDI.) +81 0442086 5513/14 Plt a, Door a 2010, ache Colony, Sut Beach Rad, Tucorin 628 01. NDIA.) : +81 SBT 26718 MANGALORE: shop Wa, Door No.5, ul Xaver, Apart Raa, Vk Mopar, Panmagaru, Mangalce-75 O13. INIA ©: 0824-2972719 Reg.No:50275 ECG REPORT Date: 22/07/2019 Name : _Mr.Senthil Bodiboyan Age : 3¥rs Sex : Male RefBy : DR. AH.BALAJI, MB.BS,FCIP,PGDPC,PGDHSC,PGCIH,, Impression : Normal Sinus Rhythm, RENAL, a cn re ‘Ceqsutant Babette ana ag. No. 58217 “HEALTHIER MARINERS TOWARDS A WEALTHIER NATION”‘An ISO 9001 : 2015 Accredited Organization @& 1: info@balajimedicaicentre com, dr@balaimedicalcentre.com + Ol Ne.18, New No.4, Jagaeeswaran Set, Taga, Chenna-60 O17. INDIA): +81 044-2498 4651/32/83 No38, Mano Seiasan Wagar an Roa, Ra Cand Se, Perunqd, hena 50 086 DLA.) +91 044-2086 8818/14 Pee, eo No 2010, Race Coon, South Beach Road Tazo 628 01.INIA. ): +81 M8410 28719, 42/1888, Olé Railway Staton Read, Erahulam Nor Kochi- 682 O18 INIA. @ : +81 04842088006 / 07/08 + Door Mo.39-11- 63/1, Murall Nagar, Vsathapatram, Andhra Pragech-830OD7 INDIA. +81 O881-2710288/ 388 0p, Doo No:-5/31, Kur aver, Aor Rod, Vie Nga Pannogrs, Mangaloe-SS 013, NDIA @ 08242972719 Reg.No:50275 DIGITAL RADIOGRAPH - CHEST PA VIEW, Date: 22/07/2019 Name : Mr. Senthil Bodiboyan Age Sayrs Sex : Male RefBy =: DR.A.H.BALAJI, MBBS,, FCIP, GDPC,PGDHSC,PGCIH ‘The cardiomediastinal silhouette is normal. ‘The lungs are well inflated, No focal mass lesion, lobar collapse or consolidation is seen, No pleural effusion is detected. ‘The soft tissues and bones appear unremarkable. Conclusion: ‘+ Normal chest radiograph. “HEALTHIER MARINERS TOWARDS A WEALTHIER NATION”ee ee ec Se ee Reg.No:50275 LABORATORY REPORT Name Mr. Senthil Bodiboyan Date: 22/07/2019 Age Syn Sex : Male Reference OES Ref By DR. AH.BALAJL, MBBS, FCIP, PGDPC, PGDHSC, PGCIH MICROBIOLOGY Quantiferon for TB - Negative (0.013 u/m) <0.35 : Negative >0.35: Positive ‘AA. BALAJI aes FIP sensor’ PoOHsC Ms ‘Agproed by Decorate General of Shopng Constant Diabetoogst and Payenoogst eg, No. 58217, “HEALTHIER MARINERS TOWARDS A WEALTHIER NATION”‘An ISO 9001 : 2015 Accredited Organization & [: info@balajimedicalcentre.com, dr@balajimedicalcentre.com Chennai-600 O17. INDIA © : +81 044-2496 4651/52/53 iv Gandh Sale, Perungal, Chem 600096, NDIA): +81 044-2988 813/14 ‘South Beach Road Tucrin = 628 00. NDIA. ©: +91 9840 26718 006 07/08 TUTICORIN Pit Wo51, Dor No.2/10, Roce Koc! 42 1888, 04 Raliway Station Road, Ernakulam Worth, Kochi- 682 018. INDIA. ©: +8 048 VIZAG = Door Wo. MANGALORE : Sop 5, Dor Na1-8/1, at Kavor, prt Roa, Vik Naga, Panjimogera, Mangalre875 O13, INDIA @ : 0824-2672719 LABORATORY REPORT Reg.No: 50275 Name =: Mr. Senthil Bodiboyan Date : 22/07/2019 : 34 Yrs Sex : MALE Ref By + DR.A.H.BALAJL, M.B.B.S, F.C.1.P, PGDPC, PGDHSC, PGCIH. TOTO cvierestow <= Wesson cs vor | REFERENCE MALARIALPARASITE | NEGATIVE NEGATIVE (x00) PF BALAJI mace ae epee nord breete comarca oan seepaee ‘Reg. No. 56217 “HEALTHIER MARINERS TOWARDS A WEALTHIER NATION”‘An ISO 9001 : 2016 Accredited Organization frov) (BB: info@balajimedicalcentre.com, ér@balajimedicalcentre.com (CHENNAL : 016 Wo.18, New Wo 4, Jagadeeswaran Street, Tat, Chenra-600 O17. NDIA: +91 044-2496 4651/52/53 Na, Manoa SrinasanNapr Main Rad, Fav Cand Sal, Parunut,Chenna} 00096 INIA. ): +91 044.2088 513/14 TUTICORIN: Plt Wt, Door Wo 210, Race Colony, South Beach Ren, Tico - 628 001. INIA.): +81 8841026718 KOCHI: No2/ 1896, Ol Railway Statin Ron, Ernatulam Nort, Kochi 682 O18, INDIA. @): +91 O484-2995006/ 07 / 08 VIZAG —_: Door Wo.39-11- 63/41, Mural Magar, Visath dra Pradesh590 007. NDIA +81 08812710209 388 MANGALORE: Stop Wo, Dor Mo 1-65/3, Klatt, Apt Road, Vek Nagas, Paiimegars, Mangalore-575 013. INDIA: O824-2972719 Reg No :50275 LABORATORY REPORT Name: Mr. Senthil Bodiboyan Date: 22/07/2019 Age : ats Sex: Male Reference : O85 Ref By DRA.H. BALAJL, MBBS, FCIP,PGDPC.PGDHSC,PGCIH TeaName Real Tal Betnerad ‘LIPID SCREEN, SERUM (Spectrophotomety) Cholesterol TL Mensrementin the same patient can show physiological canal variatons:Tve serial samples 1 week apart ae ‘recommended for Total cholesterol, Triglycerides, HDL é LDL Cholesterol § eee 2. _ ATP! recommend a complete lipoprotein profile asthe inl est for evaluating cholesterol. 3 Friedewald equation to calculate LDL cholesterol s most accurate when Trghycerde levels <400 mg/L. Measurement of Direct LDL cholesterol ecommended when Triglyceride levels >400 mg/d. TNTERPRETATION TOTAL "Wilveeride TDL CHOLESTEROL CHOLESTEROL | inmgidL Inmg/at, inmy/al ‘Optimal =m 50 ~ 23075 35 x Joining Vessel = Signature Recess Date 2-91-22Balaji Medical Centre ‘An ISO 9001 : 2015 Accredited Organization 2: info@balajimedicalcentre.com, dr@balalimecicalcentre.com [CHENNAI 01 Wo.18, New No.4, Japagesvaran Street, Nap, Cheana-S00 017. NDIA ©): +91 044-2436 4581/52/53 ‘No, Mao rnvasan Maar Main oad ap Gand Saal Perungl Chea-60 086 NDIA. ©): +81 044.208 8813/16 TUTICORI Pot No oo No 20/0, ach Clan, Sau Beach Ron, Tecorin- 628 001. MDIA.@ : +81 S841 26719 No.2 / 189,04 Raway Satin Road, Ernaklam Wot, Koch - 682 O18. INIA. @: +91 04842980006 / 7/08 oct ZAG: DeorNe.39-11 6341, Mural Napa Vsadapaaam, dra raes-50 007. MOA. 691 081-2710238/ 298 ANCHLRE: hap 5, nr N85, Ket Apert Red a ap Pnjinogae Mangal O13, MOA © 082-2672718 Date: 22/07/2019 Reg.No: 50275 Name + Mr.Senthil Bodiboyan DOB: 31/03/1985 PP/CDCNo : 23307534 Rank : Rope Access Level 3 Supervisor Ref 2 OES DRUGS SCREENING IMPRESSION Test curorumrr RESULT 1. Amphetamine/Urine 1000. ng/ml Negative 2 Opiates/Urine 300. ng/ml Negative 3.Cocaine/Urine 300 ng/ml Negative 4THC/ Urine 50 ng/ml Negative 5. Methadone/ Urine 300. ng/mg Negative 6 Benzodiazepine /Urine 300 ng/mg Negative 7.Metamphetamine /Urine 1000. ng/ml Negative 8. Alcohol/Serum 40 mg% Negative 1A postive resulta celyprosonce of the drug metabolite above the cu of valu an doesnot nde or measareinkoxcaon. 2 At with any ther beatles he sls bed eve aan aan aso te nerpeel at ca Aindigs pat & present ical sor, tedeatons taka toverage his a ter evant dt {3 Theabove ermal value conform sana adr Method: For Drugs of Abuse: Chromatographic Immunoassay Method For Alcohol Enzymatic Method BALA! hope Cone ot Spe agrees Decora Cane tS ‘enna’ Dabeonst and Poeraogst og. No 86217 “HEALTHIER MARINERS TOWARDS A WEALTHIER NATION”eee. Sen eee ge is repre srerelote ogee one LABORATORY REPORT Reg.No: 50275 Name Mr. Senthil Bodiboyan Date : 22/07/2019 ‘Age 2 34¥rs 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) 6.0 45-8 ‘SPECIFIC GRAVITY 1.020 1.010 - 1.030 ‘GHEMICAL 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] /npf 0-2 US CELLS (WBCS) 12 | fpf | 0-5 EPITHELIAL CELLS 23 | mpi |o-s CRYSTALS ABSENT | /hpf | ABSENT cast ABSENT | /hpf | ABSENT AMORPHOUS DEPOSITS ABSENT | /hpf | ABSENT BACTERIA ABSENT | /npf | ABSENT Drtan masse pesca Xproved by Orectrate Great of Spe Conair Dapetoogst ang Paychoupet ee aap Na ST “HEALTHIER MARINERS TOWARDS A WEALTHIER NATION”‘An ISO 9001 : 2015 Accredited Organization & 52: info@balalimedicalcentre.com, ér@balajimedicalcentre,com CHENNAL : 18 Jagateeswaran Street, TMagar,Cheani600 017 INDIA ©: +81 044-2436 4881 / 52/88 No.8, Mand rnvasan Nagar Main Rea, Raji Gand Sli, Pump, Cheana-600 086. INDIA. TUTICORIN; Pete, Door Na 20/10, Roche olny, South Beach Rad, Tucerin- 628 OO. INDIA. @): +81 SB410 28719 oct Read, Ernakulam North, Koch - 682018. NDIA. @: +1 0484-226 Pradesh-530 007 INDIA. @:+91 Reg.No: 50275 LABORATORY REPORT Name ‘Mr. Senthil Bodiboyan Date + 22/07/2019 fee 34¥es Sex: MALE er By DRAH.BALAN MBBS, CIP, PGDPC, PGDHSC, PCCM COMPLETE BLOOD COUNT (CBC) OBSERVED ‘BIOLOGICAL INVESTIGATION VALUE UNIT REFERENCE INTERVAL. ERYTHROCYTE (RBC) COUNT Sa mill/cusmm 47-60 HAEMOGLOBIN (Hb) 154 | gm/dl 135-18 PCV (PACKED CELL VOLUME) 36 (|% 42-52 MCV (MEAN CORPUSCULAR VOLUME) 85.1 a 78-100 MCH (MEAN CORPUSCULAR HAEMOGLOBIN ) 300 Pg 27-31 MCHC (MEAN CORPUSCULAR Hb CONCN) 352 s/al 32-36 RDW (RED CELL DISTRIBUTION WIDTH) 135 % 115-140 ‘TOTAL LEUCOCYTES (WBC) COUNT 7600 | Cells feumm | 4000-10500 ABSOLUTE NEUTROPHILS COUNT 4425 yemm 2000-7000 ABSOLUTE LYMPHOCYTE COUNT 2493 yemm 11000-3000 ‘ABSOLUTE MONOCYTE COUNT. aid yom 200-1000 ‘ABSOLUTE EOSINOPHIL COUNT. 236 yom 20-500 ‘ABSOLUTE BASOPHIL COUNT. 38 Jem 20-100 NEUTROPHILS 582 | % 40-80 LYMPHOCYTES 328 | % 20-40 MoNocyTES 54 % 20-10 EOSINOPHILS 31 % 16 BASOPHILS. os % oz PLATELET COUNT 207 10°3/ul 150-450, | MPV (MEAN PLATELET VOLUME) 69 a 695 PCT (PLATELET HAEMATOCRIT) 03 % 02-05 PDW (PLATELET DISTRIBUTION WIDTH) 159 % 9-17 Caen ‘Aaproved | General of Shipping ‘Consuitan isbooogst and Payencagst ‘Rog. No $8217 “HEALTHIER MARINERS TOWARDS A WEALTHIER NATION”‘An ISO 9001 : 2015 Accredited Organization 1: info@balajimecicalcentre com, dr@balajimedicaleentre.com Old No.18, New No.4, Jagadeeswaran Stet, Napa, Chenn-800 O17. NDIA): +81 044-2496 4851/52/38 Pt NS, Door No 20/10, Roche Calo, South Brac Road Tucorin- 628 01. NDA. +91 9881028718 + No.2 / 1898 Of Railway Staton Read, Ernakulam Woh Koch - 682018. NDIA. >: +91 0484-2395006/ 07/08 |, Maral agar, Visakhapatnam, Andhra Pradest-590 007. NDIA. +91 088 + Door Wo39-1 Shap Na, Door No.-65/31, Karavi Read, Vek Naar, Panjos MEDICAL CERTIFICATE OF FITNESS FOR OFFSHORE WORK (Issued in accordance with Oil and Gas UK Guidelines) NAME ‘MR. SENTHIL BODIBOYAN DATEOF BIRTH: [3170371985 EMPLOYING OES COMPANY NAME: ‘OCCUPATION: ROPE ACCESS LEVEL 3 SUPERVISOR This individual has been examined in accordance with Oil & Gas UK Guidelines and is Medically Fit for Unrestricted Offshore Work. EXAMINING DRAH BALAI PHYSICIAN NAME: OIL & GASUK PIN | OGUK/20087 1266 NO: DATE OF 2/07/29 a EXAMINATION, 10288 / 398 aor 575 013, INDIA. : 08242872719 —Agproed by Oeecote Gna ct Shining _P1N No. OSUK/ TAI TTY Disdeblops! and Psychologist eg: No. 55217 DATE OF EXPIRY | 21/07/2021 BALA OF CERTIFICATE: Qos, paar SIGNED: uss sCirtauebre pe say 1-6 GAS UC APPROVED ROT Balaji Medical Centre ‘No.8, Manoa SrinasanNapar Nain Roa, Rav Gand Sal, Perungul, hemna-600 O56, NDIA. @): +1 044-206 8819/14 wen “HEALTHIER MARINERS TOWARDS A WEALTHIER NATION”‘An ISO 9001 : 2015 Accredited Organization & [: info@valajimecicalcentre com. ér@balajimedicalcentre.com ‘CHENNAI 0 No.1, Hew Wo. Jgateeswaran Street, apr, Cheeta 800017. NDIA ©: +01 04-2438 4681/82/83 "No, Manto Srinasn Raga ain Roa, aj Gandhi Sala Prugud Chena 00 OB. MDA: +91 842886 813/14 TUTICORIM Pot a, Dor Ho.20/10, ache Colony. South Beach Road Tear 626 O01. IIA) ‘Old away Statin Read, Ean Nr, Koch 682 018. NDIA. @ fesh490 007. NDIA +81 08812710200 / 390 ar 575013, NOIR : 08242872718 Date: 22/07/2019 Reg.No:50275 MEDICAL FITNESS CERTIFICATE This is to certify that I have examined Mr. Senthil Bodiboyan Who is found to be Medically FIT. He is not found to be suffering from any contagious Disease or Ailment. He is FIT for Offshore Duty. ohdetns sas scirheohretee pars: 080 Arproel by Drosera General f Shing ‘Constant aoa and Psyenoog Rag. Na 58217 “HEALTHIER MARINERS TOWARDS A WEALTHIER NATION”‘Seoning Add 14 Issue 6 March 2008‘Medical Aspects of Fitness for Work Offshore: one case, Guldance for Examining Physicians Medical Screening Questionnaire and ‘Examination Record (cont'd) eden Examination Tiernan aan Pian Peoonate [enna —| SSS TESY rare] oe | oY [rs | [| Ps 73. [ims kus P+ |°tPlowrfsse|aty ons} ee Jue |e fel bie idl wis | " K aS = 4 —— L- am Nor Dewe ‘Medical Screening Questionnaire and Examination Record Issue 6 March 2008 oaOil & Gas| ‘Medical Aspects of Fitness for Work Offshore: Guidance for Examining Physicians ‘Medical Screening Questionnaire and Examination Record (cont'd) ‘oyou have arhave ou Been diagnosed at align any ae own? (Peas ce nd tra) 1 Seaport ve] wo Fe Wah Boos ewes 9 1 Ratmanapabare vel ry airy = Key does ao] ve) oP do, arm) [Ys | 7 abate vey 7 cnr ER er asay nl OevssaarIaaT ha any aay fears eee hve ay oft ew? 1. Becachefon or mos pa 2. empire 3 awl mene 4 Pororens einige Fore 5 Rest in| [6 Joseeshereat ace dane 7. charge nbothaiarhons [Bead seokintesnaenorode 2. Sones femora wo Bae 1 ecient tenia 1 hs nary congener 12. Fetacenrarciess Proc commie zeae HE BBE Fear = ‘Medical Screening Questionnaire and Examination Record Add 1-2 Issue 6 March 200850275 of Fitness for Work Offshore: Guidance for Examining Physicians Addendum 1 Medical Screening Questionnaire and Examination Record Medical Screening Questionnaire and Examination Record ene: Bo, BSAA [Rowen c pasowe: 9.137 PuDu EPR, visovaTeeR [rane FL-9 STE eewetnens 31. 08-1985 Saar a [Satan oe a LEvET ree ana Faron Soe Tier toreeneint fv | pada ee] i | I | E i i 3 a ! i i j SITS ‘Medical Screening Questionnaire and Examination Record Issue 6 March 2008 ‘Add 1-1‘SGHT TEST CERTIFICATE Now Ent Peter Reference No Form 8 50275 Ful Name Se nth Rak pe Acches Lever = Supeovi PPICDCIIO No 23207634 Dales Perea 9/3. 1996 DO wamavicn Cour of Eyes Ioenteaton Noes Righteye [et Eye | Both Eyes raid 6 88 66 Distance Vision | = Trai We WB NB Near Vision ‘Aided 5 5 5 orizortal Pian | "NORMAL |~ NORMAL —| NORMAL NORMAL] Fed of Vision |~Verica Pian | NORMAL | NORMAL | NORMAL | NORMAL ‘shinara NORMAL. NORMAL Colour Vision “Canter Ober |,0r _AM.BALAsL___oreby ceri that the above mentioned Candidate nas metinct met, the eye sight standard for hither designated rank/pogton asset out in ‘Annex Annex: Il" for seafaring oceuption picts ers AI. ap eeaaaie ‘Apprased by Oieciorale Gonata-et Shipping, Candidate's Signature Senate i aT ana Dotezo7@ot9 st _GHENNAL BALAJI MEDICAL CENTRE No Offi Same apaseswaran Stet Tote Naga Crem hone: 0-266 51/298 452/208 8 41) This certiicate i vad fortwo years fom the above date, New entry sight tet cerifcales should be retained by the candidate til his active sea career 2) Seafarer aggrieved bythe decision ofthe Medical Examiner may appeal as per te provision ofthe MS. (Medical Examination Rules, 2000 a8 amend. * Delete it not applicable, Note: The principal rules were published in the Gazette of India, Part I section 3, sub-section ( vide Notification Number SR. (E) cated the 19"Janvary, 2000,‘Annexure -IV Medical Certificate for Service at Sea {Hesuod under the Authority of Deectorate General of Shipping, Govt. of nda under Rule 4 of M.S. (Medical Examination) Rules,2000 as amended BODIBOYAN SENTHIL (Seafarer Name: Last Firs, Mie) eo pmiee ge Date of ith: (Sm) Gender (tateFemale) Indian Passporv COC No.__zann7ss4 __valid unt) = has been examined by _DR. AH BALAI _TNICH/13/2016 (Name of Medical Examiner and approval no) ‘and has been found fivunftfor service at sea in the job of_ ROPE ACCESS LeveL\ Unf Temp Unf Specty Reason- (2) Te hearing and sight of the seafererconcemed, and the colour vision nthe case ofa seafarer to ‘Be employed capacties where ness forthe work to be perormed i lable tobe affected by defective colour vision, are all salsfactory. and (©) The seataer concerned is ot suring om any mecical cancion tkly to be aggravated by service a sea orto render the seaforer unt or such service oro endanger the hea of ether Persons onboard (6) The seatarer complies withthe requirements specified in Table A‘/8 of STCW Code (Le. Minimum In service eyesight standards fr seafarers), Table 6-19 ofthe STCW Code (.e. Assessment of ‘minimum enty level and in-service physical abies fer setarers) and Regulation 1.2, Standard A-12 {Guideline B- 12 fine Marine Labour Convention 2008, 7 220772019 4 CHENNAL mans rciNbebupcorc pcre. 048) (Date & Pace of Medical Examination) ei Rog. Ne 56217 Addcess- NAO 1B.NGADEESWARAN ST, TNAGAROI-. info@balmedeatontrecom a ane MEDICAL CENTRE —— Miner {Not more than 2 years rom te da of sau, ules the savers under a ageo 70 {temantrum pera of aka ofthe Meal Crtcala sab 1 yor) the prod of vay of the mada! ‘arate expresin be course a voyage tan fe medal cericatshat conn ob ne ors perad ret tceeing tree month rom th dat of xp or ntl te nespoo eat where an eproves Medea! Crain ie aalable andthe eeaaer can get examined and obiirenewod medal cereale fom the Nades!BALASI MEDICAL, CENTRE NNAONTRJAGADE SWARAN ST, TNAGAR, (CHENNAI -600017 Ph: 044-2436 4651, 52,83 Vesset: smal: dr@bulinedcalsnrcom infobalainedicalcente com Name: BODIBOYAN SENT Sex M_ SerialNo: $5313, Date of Birth 31/9/1985 ppicne "23907634 Rank: ROPE ACCL 3 SUPER vif oe Type: Route: Home Address: 207 PUDU EAR VADAVATHUR ERUMAPATTLNAMAKKAL 37013 INDIA. ase answer the following to the best of your knowledge: ee ae Ta = OBE Ta = [Systemte Examination — [wat Tse setae ree fm ary mas ee ncn key to beans by seve farsa Stara etree te str ito eT Sucrsevce orto wager heat Oe z Z ‘ther pesan on ar? YES Pisses Za urae ‘Candies Signature Date: 22JuL-2019 “Tereearty unre ‘On te bass of te examinees story, Gc narabon ahd Gayponc ea, 1 BFA. GALA, Tereby dedi the Goris Ra na Nas Peanenty vt» Balaji Medical Centre BOSS n1S0 0208 Acted Oeizaton Eu eg aa, [CHENWAL: 014 N18, Now Nod apadoornara Sat, Taga, henen-600 017. NDI : +01 046.248 4081/52/53 "3, anal Steen Hag Masa Rose a and Sala, Panga, Chnna- 600086. MOA): +81 97881485 OCH: MeA2/S40, Ole Raway Staton Ress Eran Mart, Koeh-6H2 018 NDIA. @): +91 0484239500607 / 08 ZAG: OsorNe.9-11- 6/41, Maral agar, Veakhapetnm, Andhra Pradesh$90 007. INDIA +81 8812710208 / 298 MMNGHLORE: Shop Ne, Dor No:1-48, Kr att. Ape Ran, irk Rap, Paningar, MangaloreS7S O81. INDIA = O824-2072718 PRECOUNSELLING AND CONSENT FORM Date: 9.2.-01- Derg Name |SexTmC buys even Rank: Ro7e AccESS Levers -SuPERWseR | Reg.No 50 1S Company: 065 Please sign to indicate that each aspect ised below has been fully explained by the counselor / Doctor, to your satisfaction inthis pre-test counseling session 1. What the tost moans : “The testis for HIV 18 2 antibody, this testis for assessing Infection which may have occured ‘more than three months earlier. A positive test require a confirmatory testing (WESTERN BLOT) before diagnosis of HIV postive statu. 2. Whata positive result means : ‘Antibody to HIV indicates infection, Presence of antibodies to HIV do not necessarily mean you are suffering fromAIDS. 3. Whata negative result means Anegative results means no infection. However, high risk unsafe activites and contacts within the last twelve weeks needs a repeat test later 4, Whatare the assurances regarding confidentally Result of test should be collected in person only and /or sentto the referring physician in a sealed envelope. Preventive aspects irrespective of the test result: Keep yourself, your partner and the community safe at all imes by avoiding unsafe behaviour ‘which may lead to HIV transmission / irrespective of the test result. | save read the information provided and have had the opportunity to ask questions and clarify tformation and the issue concening the HIV antibody test. These issue have been explained to my ssalisfaction inthe languages | understand, | give my informed consent for taking my blood sample to test for the HIV antibody. Signatur ofthe Gustomer Patient: B-CeoRt ane stg d Consutant ene fag No sty Om Signature of the Doctor / Counsellor