REPORT OF MEDICAL EXAMINATION OF SEAFARER BY APPROVED MEDICAL EXAMINER OF 0G SHIPPING GOVT. OF INDIA. ‘As por merchant Shipping (Medical Examination) Rules 2000 and ISM / STCW code 1 $8 and ILO convection 147 'SEACARE MEDICAL CENTRE 212, Nagao Doctors Pica, Siakulam, Andhrapadesh, Pino: 532001, Ind, Phs05S57022 EMAIL: skim seecaragmal.com iame Surame: LANKA Fst AN wale Corns Name Name ie orBity 068-984 Press: Narrseus Rank: SRDENGINEER Sex Male fre ft Vester SEAMAYS: Te = Rows lone Aides: GOWDU STREET, MONOEMKHALLU, KURUPAM, V2ANAGARAM PWV £3558, ANDHRA PRADESH, NDIA company Name_KOTUG MIDDLE EAST DMCC _ edict isto Please anewar te folowing othe best of your Rowldge intron pe peso na a Cadanes Eanes ete Son? Sccwetae —Sacaoten Sictser bebo Seer oe soe ie rae) % 7 Reniyaocpee % 7 toodnaeotisorae Nan y 2 ~ [ge tesco Dish z z Tacacnesnearesg z YL Mbateniveticentnee ¢ ¢ te vt PG EE z 7 hoodoo z z a z 7 tonto Das ie z arNooarvct ote ’ 1 patron sennngecenss ’ ‘Seree) Gree ere 4 ¢ —|[Pesssosieserpnepan 4 4 Sa sere ae Ser z Yaa opm z z Sandatieraoresr z 7 once z z mone rs z 1 Wana aoa z z eecanrsr z 7 Mtge anes com z z Feet Dao y 1 Spd onedes yuraesioed Vit yoote i [Mesical Examination fisrtncns —__Wegninkgs | Ousthaptp BP nw | Puseteauan Tsp Rainn | Gonreannon secu saxo wee 12074 wig gunn ‘enn 6000 lott Vision Coren Unconeetes Field Vein Aaclometry We 820 1000 2000 3000 4€00 4200 peo rote _ “ Noma RghtEw a8 90 2200s lene = ws Nomsi Leh a8 (25 2015 +10 OS 8 i Vi wsira NORMAL ‘normal agar Let ea Others: Abnormal Heard Nona NORMAL yt Examiration Worst Abnomat Respir Si Nowmal —Tabponmat fees Angee ™aD Cersevesou Sym aD kere nao Per abcomen nao [earmowervat no Cente Uinar Sitem nao eesvOrl Cay nao one mt oe Seton Si nao fmt Hem roca uw a Yate vere Fn Floss mi Investigations - [Boos ena Normal Range Tine Renu fRevegom 78 Caer ae Yeo [Toa Wec count ea 00-1000 comm spect Gravy 1.015 Inou 58 mp 38 Eas (Of aomo 02 oso OD cio fina - ‘Neu Ni lese 0 2m Suge Anson lscer x mela, Biegrent —— Abvent Is cross 1 "E0280 mod Bie Sho Absent 5 Tracom ‘08 020 ma Ceat8oos been [Blood Sugar % “upto 140 moval ‘RBC cells hoses Negative avec bavi NeGaTvE Ober hort NeGATVE — Spirometery fom com ue Drug Of ABUSE NEGATIVE FO Jeo os “or Posie feo wnt r= use NORMAL ay Chat wnt — ~ tesult Of medical Examination: - nthe tals of fe examinee hoy cncal ané dagnoste fab | Or Ord, Jago Nadu Terey_dedae_te_eamnes mecca, ft Pemanenty Ut “enor Unt ‘econende examen ar ‘onecanonts no aldu ty Ma alnomaion eqred unde Amex E and Fo W'S (Wade Exarinator Ries 200) ini Cotete ene 10042024 09.04.2028 ance Snare DR. MUDDADA JAGGU NAIDU L: Aer M.8.3.5.. MS (Orthopedics) fpsie 1004-2004 Face Sokaulam mee Scanned wit! nce D.G. APPROVAL NO.AP/SKM/OL ‘APPROVED BY D.G.SHIPPING GOVT. OF INDIA h CamScannerSEACARE MEDICAL CENTRE #212, Nagavali Doctors Plaza, Srikakulam, Andhrapradesh, Pincode: 532001, India. Ph:6305557922 EMAIL: skim.seacareagmail.com Medical Certificate for Service at Sea LANKA ANIL (Seafarer's Last name, First name and Middle name) N2775848, (Number of: CDC/PassporVother valid identification document - with type of do Dr.M. Jaggu Naidu (Name of Medical Examiner) and has been found fit for service at sea in the job of SRDENGINEEE: has been examined by (a) The hearing and sight of the seafarer concemed, and the colour vision in the case of a seafarer to be employed in capacities where fitness for the work to be performed is liable to be affected by defective colour vision, are all satisfactory; and (b) The seatarer concerned is not suffering from any medical condition likely to be aggravated by service at sea or to render the seatarer unfit for such service or to endanger the health of other person on board. © The Seafarer complies with the requirements specified in Table A-V9 of STCW Code (i.e. Minimum in Service eyesight standards for seafarers), Table 8-1/9 of the STCW Code (L.e. Assessment of minimum entry level and in-service physical abilities for seafarers) and Regulation 1.2, Standard A-1.2 & Guideline B-1.2of the Maritime Labour Convention 2006 10-04-2024 ) Srikakulam RMu ve ones (Date & Place of Medical Examination) (Sianguyre othe Sudéicar tammy) “ARE MEDICAL CENTRE iaz34 Bpikakulam, Dretons “etna ARLE. OF DA skim.seacaredgmail.com 1091 i (Address with E-mail ID & Contact No. (Serial number of the Certificate) ty hasical Exagaiver 09.04.2026 SEACARE MEDICAL CENTRE jres on* + i This Certificate expires on’ - ome A Neg tor FA ej a a i rs as ae Sato tn. Ifthe period of validity of the medical certificate expires in the course of voyage, the medical certificate shall continue in force until the next port of call where an approved Medical Examiner is available and the seafarer can obtain a medical cortificate, provided that period of such extension shall not exceed 3 months. Scanned with CamScannerSEACARE MEDICAL CENTRE (An 1S0 9001 : 2035 Accredited Organization) Ph: 08942- 464936; Email: skim.seacare@zmail.com #212, Nagavali Doctors plaza, 80 feet road, Near SBI, Opp. Geetham College, Andhrapradesh, pin: 532001, India SIGHT TEST CERTIFICATE Appendix - V New Entry" / Periodic" Reference No. 4091 _ heme: Full Name LANKA ANIL Rank SRD ENGINEER PP/CDC/IDNo. — 1N2775846 Date & Place of Birth | 04-06-1994 Colour of Eyes: BLACK Identification Notes: _AMOLE ON LEFT EYE Right Eye | Lefteye Unaiced Distance Vision 58 $8 Aided |= 7 S = Unaided RMA Near Vision $8 os. a NORMAL | Aided | c z si Horizontal Plan Field of Vision N f 7 NORMAL Vertical Pian | N N N NORMAL Ishihara |NORMAL __ NORMAL Lantern / Others the eye ‘occupation. LA ight sta indard for hist hereby certify that the above mentioned candidate has metinot jesignated rank/position as set out in Annex-II"/Annex-lll* for seafaring DR. wuts JAGGU NAIDU. Candidate's Signature Sig ibe S.. M.S (ett dies) 10-04.2024, SRIKAKULAM Exgminer oREamoer ss Agster and Date ee BG. APPR ewacsmad/SK/01/2022 Note: APPROVED BY D.GSHPPING GOVT. OF INDIA 1) This certificate is valid for two years from the above date. New entry sight test certificates should be retained by the candidate til his active sea career. 2) Seafarer aggrieved by the decision of the Examiner may appeal as per the provision of the M.S. (Medical Examination) Rules, 2000 as amended. * Delete if net applicable. Scanned with CamScannerSEACARE MEDICAL CENTRE (An ISO 9001: 2015 Accredited Organization& Under ASWA Maritime Trust) Ph: 08942-464936/ 6305557922 Email: sklm.seacare@gm; #212, Nagavali Doctor’s Plaza, 80 Feet Road, Andhra Pradesh, Pincode: 532001, India. SERIAL NO: 1091 DATE: 10-04-2024 NAME: LANKA ANIL SEX: MALE RANK: 3°° ENGINEER D.O.B: 04-06-1994 COMPLETE BLOOD COUNT TRBC 4.5-6.5 mill/cumm Heamoglobin 14-16 gm% HCT 40-50 % MCV 83-101 FL MCH 27-32 PL MCHC 32-36 % ‘TWBC 4000-11000/eumm. DIFFERENTIAL COUNT Neutrophils 58 40-75% Eosinophils 04 26% Lymphocytes 36 20-40% Monocytes 0 0-4% Basop 00 01% Platelet Count : 2.81 150-450 Lakhs/eumm ESR 10 0-20 mm/1*" Hours Blood group “0” POSITIV og ure Scanned with CamScannerSEACARE MEDICAL CENTRE (An ISO 9001: 2015 Accredited Organization& Under ASWA Maritime Trust) Ph: 08942-464936/ 6305557922 Email: skim.seacare@gmail.com #212, Nagavali Doctor’s Plaza, 80 Feet Road, Andhra Pradesh, Pincode: 32001, India. SERIAL NO: 1091 DATE: 10-04-2024 NAME: LANKA ANIL SEX: MALE RANK: 3°? ENGINEER D.O.B: 04-06-1994 EXAMINATION OF URI TEST DONE OBSERVED VALUE : 20 mi 7 Pale Yellow Appearance 2 Clear PH 2 65 Specific Gravity : 1.015 2 TRACE Sugar : ‘Absent Bilesails 2 Negative Bile pigment : Negative Occult blood z Absent. Absent Puscells. Absent Epithellal c ‘Absent Casts: Absent Crystals Absent Yeasts Absent ‘Sperms : Absent “at centee? 0g, Aki PE a APPROVED BY D.G.SHIPPING ‘cov OF oa We Serve With Care- Scanned with CamScannerSEACARE MEDICAL CENTRE (An ISO 9001: 2015 Accredited Organization& Under ASWA Maritime Trust) Ph: 08942-464936/ 6305557922 Email: skim.seacare@gmaii #212, Nagavali Doctor’s Plaza, 80 Feet Road, Andhra Pradesh, Pincode: SERIAL NO: 1091 DATE: 10-04-2024 NAME: LANKA ANIL SEX: MALE RANK: 3"? ENGINEER D.O.B: 04-06-1994 ‘TEST — NORMAL VALUE Fasting blood Sugar 78 70-150 m Creatinine 09 VDRL NEGATIVE HBsAG NEGATIVE HIV NEGATIVE Blood Grouping Rh Typing O+ (positive) DR wnt hiocn NAIDU M25. M5 (Onhopedi SEACARE MEDICAL CENTRE REG, NO. 83450 D.G. APPROVAL NO.AP/SKM/01/2022 ‘APPROVED BY D.G.SHIPPING GOVT. OF INDIA Scanned with CamScannerSEACARE MEDICAL CENTRE (An ISO 9001: 2015 Accredited Organization& Under ASWA Maritime Trust) Ph: 08942-464936/ 6305557922 Email: sklm.seacare@gmail.com Nagavali Doctor’s Plaza, 80 Feet Road, Andhra Pradesh, Pincode: 532001, India. SERIAL NO : 1091 DATE: 10-04-2024 NAME : LANKA ANIL SEX: MALE RANK: 3°? ENGINEER AGE: 30/Y BLOOD REPORT Parameter Test value Normal value (QBC) Malarial parasite Negative HAV Negative — HBsAG — Negative HCV Negative 7 DR. wollte, NAIDU M.B.2.5., MS (Orthopedics) SEACARE MEDICAL CENTRE REG. NO. 83420 DG, APPROVAL NO.AF/SKM/01/2022 APPROVED BY D.GSHIPPING GOVT. OF INDIA -We Serve With Care Scanned with CamScannerSEACARE MEDICAL CENTRE (An ISO 9001: 2015 Accredited Organization& Under ASWA Maritime Trust) Ph: 08942-464936/ 6305557922 Email: skim.seacare@gmail.com #212, Nagavali Doctor's Plaza, 80 Feet Road, Andhra Pradesh, Pincode: 532001, India. SERIAL NO : 1091 DATE: 10-04-2024 NAME: LANKA ANIL SEX: MALE RANK: 3"? ENGINEER AG! 0/Y MONTUX TEST: PPD 10 tu given on the left forearm on 05.04.2024 at 4.30 PM to read between 48-72 hours RESULT: NEGATIVE Note: Please correlate the result with clinical condition DR. win, NAIDU. M.B.3.S., MS (Orthopedics) SEACARE MEDICAL CENTRE REG. NO, 83420 D.G. APPROVAL 10.AP/SkM/01/2022 ‘APPROVED BY D.G.SHIPPING GOVT, OF INDIA Scanned with CamScannerPatient Id 1. 132625 Patient Name ‘Mr. L ANIL Age 28 years Gender : Male Dr. MJAGGU NAIDU DIAGNOSTICS et. By ‘MS(Ortho) (GO0D HEALTH MADE POSSIBLE un ne. a2s986 Registration Date and Time: Apr 05, 2028, 06:40 p.m. Collection Date and Time: Apr 03, 2024, 06:40 pm Report Date and Time + Apr 05, 2024, 06:47 pum. ‘Ultrasound KUB DEPARTMENT OF RADIOLOGY AND IMAGING SCIENCES ULTRASOUND KUB: MALE FINDINGS: + RIGHT KIDNEY: Normal in size measuring 8.2x4.0cms. Echotexture is normal. Cortico medullary differentiation well maintained. No e/o caleuli. No hydronephrotic changes or gross mass seen. No e/o hydroureter, + LEFT KIDNEY: Normal in size measuring 8.6x4.0cms. Echotexture is normal, Cortico medullary differentiation well maintained. No e/o calculi. No Hydronephrotic changes or gross mass seen. No elo hydroureter. + URINARY BLADDER: Urinary bladder is normal in capacity and contour, Walls and contents do not show any abnormality. + PROSTATE : Prostate is normal in size (vol: 10.0cc). Parenchymal echogenisity is normal. No focal lesion is seen. Seminal vesicles are normal. + PERITONEAL CAVITY: No free fluid in the abdomen, IMPRESSION: + No significant abnormality detected in present study. Dr KSAHAIR MD Oo%w GOOD HEALTH Courts. YRS info@layahealth.in www.layahealth.in MADE POSSIBLE = Poon 4 of Scanned with CamScanner“ Scanned with CamScannerSEACARE MEDICAL CENTRE (An ISO 9001: 2015 Accredi Ph: 08942-464936, 6305557922 Emai -d Organization& Under ASWA Mari ime Trust) skim.seacare@gmail.com #212, Nagavali Doctor’s Plaza, 80 Feet Road, Andhra Pradesh, Pin code: $32001, India. SERIAL NO:1091 10-04-2024 14-2023 NAME: LANKA ANIL SEX: MALE RANK: 3" ENGINEER D.O.B& AGE: 04-06-1994 ANALYSIS OF DRUGS OF ABUSE & ALCOHOL (QUANTITIVE) TEST CUT OFF VALUE RESULTS THC/MARLJUANA(Urine) SOngm/ml Negative ‘OPLATES(MORPHINE)(Urine) 300 ngm/ml Negative a ~~ COCAINE(Urine) 300 ngm/ml ‘Negative ‘AMPHETAMINE(Urine) 1000 ngm/mi Negative BARBITURATES(Urine) 300 ngm/mi ‘Negative Alcohol(Urine) 100 mg% Negative The Cut-off values are base on the recommendations of N.1.D.A & S.A.M.ILK.A. (U.S.A) Note: A P It does not indicate or measure intoxication. The urine anally ELISA RIA (RADIO IMMUNO ASSAY) itive result indicates only the presence of the 4 metabolite above the cut off value for the above are done by any one the following available assay methods. IMMUNOMETRIC ASSAY (RAPID - CHROMATOGRAPHY) FPIA (FLUORESCENE POLARISATION IMUNO ASSAY Alcohol test is done by enzymatic method on auto — analyzer or breath test of saliva test. DR. wh rec NAIDU S (Onhopedics) SEACARE MEDICAL CENTRE REG, NO. 83420 D.G. APPROVAL NO.AP/SKM/01/2022 APPROVED BY D.G-SHIPPING GOVT, OF INDIA -We Serve With Care- hovc, Scanned with CamScannerSEACARE MEDICAL CENTRE (An ISO 9001: 2015 Accredited Organization& Under ASWA Maritime Trust) Ph: 08942-464936/ 6305557922 Email: sklm.seacare@gmail.com Nagavali Doctor’s Plaza, 80 Feet Road, Andhra Pradesh, Pincode: 532001, India. PATIENT'S NAME: LANKA ANIL DATE: 10-04-2024 REFERRED BY: DR. MUDDADA JAGGU NAIDU DIGITAL RADIOGRAPH OF CH PA VIEW The lung fields are clear Heart and aorta appears normal Both hila appear normal Both costo-phrenic angles are clear Visualized bony thorax appears normal IMPRESSION: NO SIGNIFICANT ABNORMALITY IS DETECTED. Clinico-haematological correlation is recommended. ‘Thanking you for the referral, With regards, Dr.SN.R!MURTHY CONS RADIOLOGIST Scanned with CamScannerREF. DOCTOR : SELF TACCESSION NO: IMO7291503 JpeeNTID — LaNIMS36025910 CLIENT PATIENT ID: 107281501, |aBHa NO PATIENT NAME: LANIL 28 Years Male 07/04/2024 14:28:23 (08/04/2024 13:43:26 (09/04/2024 14:28:47 [Test Report Status Final, Results Biological Reference Interval Units ENDOCRINOLOGY g/m. NICOTINE METABOLITE <10.0 Non Smokers : < or = 25.0 ‘Smokers : > 25.0 ‘7nd OF Report** ‘This testis performed at our Referral laboratory. Please refer to conditions of reporting. “This report i not valid for medicolegal purposes. K Awshe DR. MUDDAUA JAGGU NAIDU 1.8.0.5 MS (Orthopedics) SEACARE MEDICAL CENTRE REG. NO. £3420 DG. APPROVAL NO.AP/SKM/01/2022 APPROVED BY D.G.SHIP?ING GOVT. OF INDIA Scanned with CamScannerFe AN ae pl sede hla O ee ae RS cream LURE SSSA eee ee Pt.Name: Mr. LAnil ‘Age/Gender: 28/Male Ref Dr.MJaggu naidu garu Date:05.04.2024 HELICOBACTER PYLORI IgG, ANTIBODY {rest RESULT REFERENCE RANG! Helicobacter Pylori IgG, Antibody om <0.80- Negative 20.80 and <0.90 Equivocal >0.90 - Positive (Method : Electrochemilumenescence) ‘The HpiorigG assay uses Chemiluminescent Immunoassay (CLIA) technology forthe qualitative Determination of 6 antibodies to Helicobacter pylon human serum from symptomatic adults as an Bid in the diagnosis of Helicobacter pyor infection, ‘Assay result shouldbe used in conjunction with other eincal or laboratory data to assis the clinician in ‘Making individual patient management decision. “Helicobacter pylori is a gram-negative, helishaped, bacterium Infecting human stomach and i. causative agent of chronic Gastritis, Duodenits and gastric ulcers itis associated with an increased risk of stomach cancer. *Sorologca testing i the first choice for the detection of H.pylol infection because of ease of performance compared to the more invasive diagnostic tests. However, a postive serologic test does not confirm the active disease. Indicates the presence of H.pylor antibodies which confirms both 2 possibilty for pat infections or potential current infections. “End of Report- Dr.Aruna K Consultant Pathologist MoE ss Suenos ace Lech ans esteb sou Scanned with CamScanner4 KOTUG RECORD OF MEDICAL EXAMINATIONS OF SEAFARER Part A— to be completed by the Seafarer who is responsible for answering each question accurately. Seafarers Name in Full) aWKA- ANDL ‘Sex MALE (BLOCK CAPITALS) Male/Female Date of Birth: day/month/year Place of Birth: Nationality: OY = Tune - 1994 MONDE Miki INDIAN “Type of ID documents: NRIC No.7 | Dept: Deck / Engine / Catering / others | Type of ship: Passport No p/ 247586 Rank: 300 cwarween ANTS — oF Home Address: 1-6, Gaoou stece, [MONDE MK HALLUW), KORUPAM(~), BVA THC 1 Routine and emergency duties: Trading area: €.g. coastal J worldwide ‘Seafarer's Declarations (please tick) Have you ever had any of the following conditions? Yes No YesNo [7 Eyehision problem v| 18 Sleep problem 2. High blood pressure | 19. Do you smoke, use alcohol or drugs? vO 3 Heari/vascular disease | 20. Operation/surgery 4 4. Heart Surgery v | 23. Epilepsyiseizures v 5. Varicose veins/piles V_| 22. Dizzinessffainting Wa 6, Asthma/bronchitis v_| 23. Loss of consciousness | 7. Blood disorder 7 | 24. Psychiatric problems Liv 8. Diabetes 25. Depression | lv) 9. Thyroid problem 26. Attempted suicide L IY} 10. Digestive disorder V | 27. Loss of memory v 11. Kidney problem ¥ | 28. Balance problem Vv [12. Skin Probie v7 | 28. Severe headaches v | 13. Allergies ‘VV | 30. Ear (hearing, tinnitus/nose/throat problem) v 14. Infectious / contagious diseases v | 31. Restricted mobility Vv 15. Hernia ~ | 32. Back or joint problem ~ 16. Genital disorder | 33: Amputation v 17. Pregnancy VW | 34. Fracture/dislocations v Ifyou answer “yes” to any of the above questions, please provide details: rorvanwousesouce ewer or aver wemaoe csr sw. coop orcouraes warn saroWRt nnuorccon um Tes oioaeni EG = wwfoaKoTuccom Scanned with CamScanner Ahead in Maritime ExcellenceKOTUG Additionalquestions YesNo 35, Have you ever been signed off as sick or repattiated from a ship? 36. Have you ever been hospitalized? 37. Have you ever been declared unfit for sea duly? 38. Has your medical cerificate even been restricted or revoked? 39, Are you aware that you have any medical problems, diseases or linesses? 40. Do you fee! healthy and fit to perform the duties of your designated position/occupation? 4. Are you allergic to any medication? 42. Are you using any non-prescription or prescription medication? ASISIRISIRISIS If you answer “yes", please list the medications taken, the purpose(s) and the dosage: | hereby declare that the personal declaration above is a true statement to the best of my knowledge. 10 04 - 2024 Le Aes Date Signature ofSeafarer e Excellence Ahead in Mariti » 2 Scanned with CamScannerKOTUG Part B — Result of medical examinations Eyesight Use of glasses or contact 7] lensesNo Yes Type mM Purpose ose... Visual Acuity Unaided Aided Right eye | Left eye Binocular__|Righteye | Lefteye Binocular | Distant 6/6 616 | Distant kM Near ele £16 | Near Visual fields Normal Defective Right eye Noval - Left eye Noymas — Colour Vision (please tick) Not tested Normal Doubtful Defective Hearing - Pure tone and audiometry (threshold values in dB) S00Hz | 1,000Hz | 2,000Hz | 3,000 Hz Right ear 30 26 20 Los Left ear 2 20 1s 10 Speech and whisper test (metres) Normal Whisper Right ear ovmat 0.3 miny Left ear Noval 0.3 mby Ahead in Maritime Excellence Scanned with CamScannerKOTUG Clinical Findings Height 153 (Ca Weight 52 (kg) Pulse rate 6y (per minute) | Rhythm. &. Blood Pressure Systolic (mmHg) | 120 _| Diastolic (mmHg) | _ #1 Urinalysis:| Glucose : wit ___| Protein: of Blood: vil Normal | Abnormal Head Sinus, nose, throat Mouth/teeth Ears (general) ‘Tympanic membrane Eyes Ophthaimoscopy Pupils Eye movement Lungs and chest Breast examination Heart Skin Varicose Vein Vascular (inc. pedal pulse) Abdomen and viscera Hernia ‘Anus (not rectal exam) G-U system Upper and lower extremities Spine (Cis, T/S, L/S) Neurologic (full/brief) Psychiatric General appearance EISISISSEISNSISSSAISIKASERK CSC Chest X-ray Not performed Ahead in Maritime Exe Scanned with CamScannerKOTUG Other diagnostic test(s) and result(s): saad MI Eg... Test ..... Results: NORmAL Medical _practitioner’s comments and assessment of fitness, with reasons for any limitations. - FOR SEA SERVICE Assessment of fitness for service at sea (please tick) On the basis of the seafarer's personal declaration, my clinical examination and diagnostic testresults recorded above, | declare the seafarer medically’ Fit for look out duty Unfit for lookout duty Visual aid required Visual aid not required Deck Engine | Catering | Other Service| Service _| Service _| Service Fit Vv Unfit y Without restrictions With restrictions ific position, of ship, trading area etc. wt 10-44-2024 DR. MUDDADAJAGGU NAIDU elf 5 \Orthopedics) Date igneture oF Medicar Pragiionet sae. aROeE number, add Si REG. NO. 83420 Medical Practitioner 6. apPROVAL’ NO.AP/SKM/01/2022 ‘APPROVED BY D.G.SHIPPING GOVT. OF S Scanned with CamScanner Ahead in Maritime Exagiience|KOTUG SEAFARER MEDICAL CERTIFICATE This cerificate is issued by the undersigned recognized medical practitioner to the named seafarer_in which he meets both the requirements of the 2010 Manila amendments to the International Convention on Standards of Trainings, Certification and Watchkeeping for Seafarers, 1978 (STCW Convention) and the Maritime Labour Convention, 2006. ‘Seafarer's Name in Full ‘Sex: MALE LANKA. ANIL Male/Female Date of Birth: day/monthiyear ] Nationality: Passport/NRIC No.: 04 fog /i9sy IwOrAn IN LAASBY6 Declaration of the recognized medical practitioner __Yes No 1_| Identification documents were checked atthe point of examination? vw 2. | Hearing meets the standards in STCW Code Section A-1/9? v 3 | Unaided hearing satisfactory? Vv 4 | Visual acuity meets the standards in STCW Code Section A-1/9? lv 5 | Colour vision meets the standards in STCW Code Section A-1/9? a Date of last colour vision test: 10 - 04-2024 v 6 | Fit for look out duty? ot |_| Is the seafarer free from any medical condition likely to be aggravated by service at | 7 | sea or v to render the seafarer unfit for such service or endanger the life of person onboard? 8 | No limitations or restrictions on fitness? v If ‘no” specify limitations or restrictions — # 9 | Date of examination: (day/month/year) 1b [OU] 2024 ¢ 10| Sxpiy Ofcertifcate: (day/monthvyear) OGJou] 20r£ 2| Maximum two years trom date of examination unless the séatarer i under the age of 18 3 DR. MUDDADA JAGGU NAIDU 5 10-04-2004 jy reece a ae % Madical Practitioner Thoms leona ech euseete) E LG. APPROVAL” NOt? /SKM/01/2022 ‘APPROVED BY O.G.SHIPPING GOVT. OF INDIA Ahead in Marit Scanned with CamScannerSEACARE MEDICAL CENTRE q 015 Accredited Organization& Under ASWA Maritime Trust) 9 Ph: 08942-464936/ 6305557922 Email: sklm.seacare@gmail.com #212, Nagavali Doctor's Plaza, 80 Feet Road, Andiira Pradesh, Pincode: 532001, India, (An ISO 900: SERIAL NO : 1091 NAME: LANKA ANIL SEX: MALE RANK: 3"? ENGINEER AGE: 30/Y DENTAL AND ORAL HEALTH CHECK UP On examination of oral cavity following findings were made: Dental caries Dental Plaque and CALCULUS”: Fractured teeth Missing teeth : Fixed partial denture/prosthesis, Soft tissue, gingival, tongue : Remarks NONE NONE NONE NONE NONE Normal Normal RESULT: Dental Fitness Certified ---We Serve With Care DATE: 10-04-2024 Ds Shara Cee AraTH eas MDS © oy Mobiles upstais, Day and Night Junction Palakonda Read, Srikakulam-532001 Scanned with CamScanner