(Passp

CMA CGM Shipping Ltd.

75 King William St,
London, EC4N 7BE,
United Kingdom.
Tel: +44 74 5127 3879
SEAFARER'S APPLICATION/EMPLOYMENT FORM - Page 1 of
3 - PERSONAL DATA ort
Photo)
PERSONAL INFORMATION.
Family Name Manoj singh bhandari First Name (s) Manoj
Birth Date 12/08/1989 Birth Place Pithoragarh
Nationality Indian Religion Hindu
Marital Status Married No. of Children Nill
Height (cm) 168 Weight (kg) 78
Nearest Airport Delhi Alternative Delhi
Airport
ADDRESS (include telephone country & area codes, advise also secondary or contact
addresses if any) secoundary contact no. +9180102 26649
Street & Nr. Roragaon Email Address manojbhandari999@gmail.co
Location Roragaon Mobile Phone m
+91 9720530708
City Pithoragarh Whatsapp +91 8954140589
State, Country Uttarakhand Number
Fax
Postal (ZIP) 262530 P.O. Box (if any) Tharkot pin-262530
Code 262530
NEXT OF KIN INFORMATION (person to contact in case of emergency & insurance
Family Name Shobha bhandari First Name(s) Shobha
Nationality Indian Relationship Wife
Street & Nr. Roragaon Email Address manojbhandari999@gmail.co
Location Roragaon Mobile Phone m
+91 84330 54629
City Pithoragarh Residence Phone
State, Country Uttarakhand/india Fax
Postal (ZIP) 262530 P.O. Box (if any) Tharkot pin-262530
Code
REMARKS 262530
Requested Chief engineer Availability Date 20/02/2022
Rank Vessel Off shore
Prefer. Minimum Salary 6000 Great British pounds per
Type
English Language Skills Spoken: good - Written: good month
Other Foreign INDIAN
Languages School /
Professional VVM inter college pithoragarh
Academy - Name & BIMS
Period (From
Foreign Crew - To) 2008 to 2009
Experience 10 year
Other Skills Malta/siriya/ukrenian/egypt/indian/iranian/phillipino/indonesiea
/ethopian/Pakistan/turkish
Further Remarks Drydock exp. Also
Please advise how you Newspaper / Advert / Google / Internet / Relative / Other Seafarer
heard about John good School / University / Other sources ……Internet and other
Shipping Company seafarer………………..
I hereby affirm that all the information provided by me in this application is true and
correct to the best of my knowledge.
Date:16/12/2021
Signature:
Note: This form can be returned per email without signature - please ensure however to send
a signed printout for our records afterwards per mail (e.g. with the passport photos and photo
copies required). Please sign all 3 pages of the application form separately.

SEAFARER'S APPLICATION FORM - Page 2 of 3 - LIST OF DOCUMENTS

Please note that due to legal requirements employment is only possible once we are in
possession of electronic copies of your documents and licenses (please refer to the Cover
Letter for further instructions).

Famil Manoj First Manoj Rank Chief engineer

y singh Name(s)
Name bhandar
i
A. TRAVEL DOCUMENTS AND MEDICAL CERTIFICATES
Document Document Number Country Issue Place Issue Date Exp. Date
Name
(Description)
Passport Z4470353 India Dehradun 16/01/2018 15/01/2028
Seaman's Book MUM 277443 India Mumbai 08/07/2017 07/07/2027
(national) Book 011924
Seaman's Honduras Honduras 20/11/2018 20/11/2023
(flag state)
Seaman's Book E 06894 Thailand Samutpraka 04/03/2009 03/03/2014
(flag -state)
Visa United n
States- Others
Visa (type
(Work/Reside.
Medical MBD3010133442 India Mumbai 30/10/2019 20/10/2021
Examination
Drug & Alcohol
Test
Vaccination 02161 India Mumbai 11/09/2019 Unlimited
against Yellow
Vaccination
against Cholera
Passport Photos please email a high quality copy of a recent passport photo.
B. CERTIFICATES OF COMPETENCY & ENDORSEMENTS, COURSE CERTIFICATES
- Deck & engine - radio certificates & endorsements - nav., deck, technical & management
certificates & - safety training (surv., fire, medical) courses (radar/ARPA, ISM, Marpol,
endorsements - tanker courses (oil, chem., gas) Simulators, computer, welding etc.)
(officers / - passenger vsl, roro, hazmat courses - any flag state certificates
ratings)
- electrical &
reefer
certificates
- cook &
steward
certificates
Document Document Number Country Issue Place Issue Date Exp. Date
Name
(Description)
Chief engineer Z 4470353 HONDURA HONDURA 20/11/2019 20/11/2023
Chief engineer END0114932/00 ST KITTS HONDURA 03/07/2020 20/11/2023
flag
endorsements &NEVIS S
Engine room REP-ERW-LIB-O4/01 LIBERIA IIMS 12/11/2011 UNLIMITA
watch keeping
INDOS No. 14ZL8100 INDIA MUMBAI D
22/09/2014 UNLIMITA
P.S.T PR6915 INDIA MUMBAI D
25/03/2017 24/03/2022
E. F. A. E9346 INDIA MUMBAI 15/03/2017 UNLIMITA
D
F.P.F.F. FR6925 INDIA MUMBAI 25/03/2017 24/03/2022
P.S.S.R. R8857 INDIA MUMBAI 22/03/2017 UNLIMITA
S.D.S.D. ST2855 INDIA MUMBAI q
06/12/2016 D
UNLIMITA
Basic Training BST/0518/OS/1195E INDIA DELHI 12/05/2018 D
11/05/2023
Endorsementin
Proficiency PSCRB/0518/AD/0864E INDIA DELHI 25/05/2018 24/05/2023
Survival Craft
Fast Rescue FRB/EN/0518/AD/ INDIA DELHI 31/05/2018 30/05/2023
BoatA. F. F. 1047E
AFF/0518/AD/0867E INDIA DELHI 19/05/2018 18/05/2023
Medical Care MC/0518/AD/0458F INDIA DELHI 12/05/2018 11/05/2023
Engine-Room ERM/EN/0618/0991E INDIA DELHI 22/06/2018 21/06/2023
Resource
S.S.O. SSO/0618/AD/0863E INDIA DELHI 12/06/2018 11/06/2018
T.A.S.C.O. 500413479 PANAMA PANAMA 31/10/2019 05/09/2024
Endorsement
Advance Z4470353 INDIA CITY
MUMBAI 05/09/2019 05/09/2024
Training
Oil for Oil
Chemical & FU1179 INDIA MUMBAI 18/03/2017 UNLIMITA
Gas Tanker D

Date:
17/12/2021
Signature:
 SEAFARER'S APPLICATION FORM - Page 3 of 3 - SEA SERVICE (LAST 10 YEARS)

Please indicate your sea service in the last 10 years as exactly as possible - required are the actual sign-on and sign-off dates according to the service certificates
resp. seaman's book entries. To speed up processing kindly indicate phone and/or fax numbers of your previous employers. Ship sizes are to be indicated in gross
tons, total engine output in kilo Watt (1 kW = 1.34 bhp) to go along with STCW limitations. Please attach evidence for the listed sea service (copies of seaman's book
entries, service certificates etc.). The information provided may be passed on to our clients and to flag state administrations to allow for verification of rank
experience. Please use the European date format (DD.MM.YY).

Family Name: Manoj singh bhandari First Name(s): Manoj Date of Birth: 12/08/1989
Vessel's Name IMO Flag GT kW Ship Type Eng.Make Rank
S/On Date S/Off Date Employer (company to
No. contact for reference)
MV LADY ITIDAL TOGO 2487 2125.5 G. CARGO MAN OILER 12/08/200 07/08/201 OSMAN GROUP PVT LTD
MV PHRHAM BALIZE 1130 910.49 G. CARGO MAK 9
OILER 02/12/201 0
06/10/201 SYRUS GROUP LLC
0 1
MT SPEED 1 PANAMA 998
1901.5 SUPPLY MWM/ OILER 07/02/201 11/12/201 SPEED DIESEL LLC
3 CAT 2 3
MT SPEED 1 PANAMA 998 1901.5 SUPPLY MWM/ 3RD 26/02/201 23/12/201 SPEED DIESEL LLC
3 CAT ENG. 4 4
MT SPEED 1 PANAMA 998 1901.5 SUPPLY MWM/ 2ND ENG 17/03/201 24/10/201 SPEED DIESEL LLC
3 CAT 5 5
MT GREEN 1 COMORO 1838 1540 ASPHALT/ MWM 2ND 21/01/201 12/03/201 ETIHAD SHIPPING LLC
S BITUMEN TANKER ENG. 6 7
MT SEA MASTER X PALAU 2114 2130 OIL &CAMICAL MAK 2ND 04/08/201 04/01/201 ASE SHIP MANAGEMENT
TANKER ENG. 7 8
MT JAGUAR TOGO 1170 1170.7 ASPHALT/ MWM 2 CHIEF 14/03/201 06/07/201 DAHA OIL AND GAS PVT
2 BITUMEN TANKER STROKE ENG. 8 9 LTD
MV DARYABANDAR ST. KITTS 498 4138.6 ASD TUG CAT CHIEF 03/11/201 09/10/202 SEA PORT LINE
4 &NEVIS 3 ENG. 9 0
TSC BORZOU ST. 250 894 TUG CAT CHIEF 20/04/202 ON TEAM SHIPPING CO. LLC
VINCENT ENG. 1 BOARD

Date: Signature:
17/12/2021