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    This application form contains personal details and documentation for Susheel Kumar Verma. Section one includes his availability, rank, name, date of birth, and contact information. Section two lists his passport, seaman book, INDOS card, vaccination certificate, and other documentation including numbers and dates of issue. Section three provides details of his STCW courses, certificate numbers, dates of issue and validity dates.

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    This application form contains personal details and documentation for Susheel Kumar Verma. Section one includes his availability, rank, name, date of birth, and contact information. Section two lists his passport, seaman book, INDOS card, vaccination certificate, and other documentation including numbers and dates of issue. Section three provides details of his STCW courses, certificate numbers, dates of issue and validity dates.

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    16 views1 page

    GGGGG

    Uploaded by

    ranjit malik
    This application form contains personal details and documentation for Susheel Kumar Verma. Section one includes his availability, rank, name, date of birth, and contact information. Section two lists his passport, seaman book, INDOS card, vaccination certificate, and other documentation including numbers and dates of issue. Section three provides details of his STCW courses, certificate numbers, dates of issue and validity dates.

    Copyright:

    © All Rights Reserved
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    of 1

    APPLICATION FORM

    01. SECTION ONE: PERSONAL DETAIL

    AVAILABILITY: ANY TIME


    RANK TARING OS
    NAME SUSHEEL KUMAR VERMA
    FATHER’S NAME RAM SWAROOP VERMA
    NATIONALITY INDIAN
    DATE OF BIRTH 30/04/1999
    MARITAL STATUS UNMARRIED
    LANGUAGE KNOWN ENGLSIH & HINDI
    CONTACT DETAILS 9456859982
    EMAIL ADDRESS Susheelverma27533@gmail.com
    PERMANENT ADDRESS VILLAGE BHAISAHA GWALPUR POST BARKHERA KALAN PILIBHIT PIN CODE 262203 (UP)

    02. SECTION TWO: DOCUMENTS HELD

    DOCUMENTS NO. DATE OF ISSUE DATE OF VALIDITY PLACE OF ISSUE


    PASSPORT U2817113 25/01/2021 24/01/2031 BAREILLY
    SEAMAN BOOK MUM492884 02/01/2023 01/01/2033 MUMBAI
    INDOS 22GM3224 28/06/2022 LIFE TIME MUMBAI
    YELLOW FEVER 24511 31/01/2023 LIFE TIME MUMBAI
    VACCINATION CERTIFICATE 94863028654 21/12/2021 LIFE TIME BARKHERA KALAN
    DC ENDRSEMENT OIL AND COPDGSOAC2393609 02/02/2023 LIFE TIME MUMBAI
    CHEMICAL
    D C ENDRSEMENT LIQUEIFIED GAS COPDGSGAS2394602 16/02/2023 LIFE TIME MUMBAI
    TANKER
    SID CARD M33066165 13/03/2023 12/03/2033 MUMBAI

    03. SECTION THREE: STCW COURSES DETAILS––


    COURSES CERTI. NO. DATE OF DATE OF VALIDITY PLACE OF
    ISSUE ISSUE
    EFA 20805461012 08/09/20 07/08/2027 MUMBAI
    201017 22
    FPFF 20805461012 08/09/20 07/08/2027 MUMBAI
    201017 22
    PST 20805461012 08/09/20 07/08/2027 MUMBAI
    201017 22
    PSSR 20805461012 08/09/20 07/08/2027 MUMBAI
    201017 22
    STSDSD 20805466212 13/09/20 UNLIMITED MUMBAI
    201017 22
    PRECSEA TRAINING COURSE 20805481012 30/12/20 UNLIMITED MUMBAI
    200275 22
    GTFC 20301651212 10/12/20 UNLIMITED MUMBAI
    300624 23
    OTCTO 20301651112 30/01/20 UNLIMITED MUMBAI
    300416 23

    PLACE NAME- SUSHEEL KUMAR VERMA


    DATE:

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