ePariksha ID: 18EL0996/MAR/7469

Personal Details

Full Name: Rahul Kumar Nationality: INDIAN Center: Kolkata

Passport No Place of issue Date of issue Passport valid till
M3393121 Patna 19 Nov 2014 18 Nov 2024
Personal Marks: Mole on right cheek Gender: Male Marital Status: Un-Married
Date of Birth: 10 Jun 1996 Place of Birth: East Champaran State: Bihar
INDOS No: 18EL0996 EXN-45 No: C.D.C. Number: KOL117873
Date of issue: 18 Sep 2019 Place of issue: Kolkata
Permanent Address: Govindapur, Govindapur, East Present Address: Govindapur, Govindapur, East
Champaran Bihar - 845411 Champaran Bihar - 845411
Telephone No: - Mobile No: 7781987707
Email ID: rahulgwish@gmail.com Alternate Email ID:

Fee Details
Assessment Fee

Receipt No Date Fee Amount Bank

YAX62270569658 14 Mar 2024 3000

Scholastic Education

Stream No.(As Per META manual):

4 years degree course in Marine Engg
(Copies of supporting document from Class X onwards
must be attached.)
Scholastic Education Level: 10th, 10+2, Graduate

Note : Any person who makes, causes to be made or assists in making any false representation for the purpose of

obtaining for himself/ herself or any other person a Certificate, shall be liable for prosecution under Section 182 &

420 of the Indian Penal Code 1860

Pre-Sea Training

Training Institute: Marine Engineering & Research Institute

Training Institute Indos: 602
Address of the Institute: P-19,Taratala Road,Kolkata,Pin-700088
Telephone No: 03324014673 Fax No: 03324014333
PASS
Email ID: director.kolkata@imu.ac.in Result: Grade as stated in record
Attended Period From : 01 Aug 2016 To: 14 Nov 2020

Copies of Supporting Document Must be attached.

Structured On Board Training

1
 Designated Training Officer Details of Certificate of
PHASE No. Date of Completion (Ship / Company) Competency
PHASE 2-As Trainee 16 Dec 2023 KAILASH K SHINDE 0064124
Engineer Officer

Sea Going Service

Name of the ship

No of Testimonial and whether Off No./IMO No. KW Trade Rank
steam or motor
vessel
ASSISTANT
1 MV HA SKLENAR 8007793 11519 Foreign Going ENGINEER
OFFICER
Date Article Period
From To From To
11 May 2023 31 Jul 2023 -- --
QSS 65
Name of the ship
No of Testimonial and whether Off No./IMO No. KW Trade Rank
steam or motor
vessel
ASSISTANT
2 MV HA SKLENAR 8007793 11519 Foreign Going ENGINEER
OFFICER
Date Article Period
From To From To
01 Aug 2023 01 Dec 2023 -- --
QSS 108
Name of the ship
No of Testimonial and whether Off No./IMO No. KW Trade Rank
steam or motor
vessel
ASSISTANT
3 MV HA SKLENAR 8007793 11519 Foreign Going ENGINEER
OFFICER
Date Article Period
From To From To
02 Dec 2023 16 Dec 2023 -- --
QSS 9

STCW Courses

STCW Regulation/ Period

STCW Approved Institution
STCW Code A From To
Institute Indos: 602
STSDSD VI
Marine Engineering & Research Institute 03 Sep 2018 07 Sep 2018
Institute Indos: 602
PERSONAL SURVIVAL TECHNIQUES VI
Marine Engineering & Research Institute 24 Sep 2018 05 Apr 2019
Institute Indos: 602
FIRE PREVENTION AND FIRE FIGHTING VI
Marine Engineering & Research Institute 24 Sep 2018 05 Apr 2019
Institute Indos: 602
ELEMENTARY FIRST AID VI
Marine Engineering & Research Institute 24 Sep 2018 05 Apr 2019
Institute Indos: 602
PERSONAL SAFETY AND SOCIAL RESPONSIBILITIES VI
Marine Engineering & Research Institute 24 Sep 2018 05 Apr 2019
Institute Indos: 605
MEDICAL FIRST AID VI
Sea Explorer's Institute Educational Trust 01 Feb 2024 05 Feb 2024
Institute Indos: 605
ADVANCED FIRE FIGHTING VI
Sea Explorer's Institute Educational Trust 19 Feb 2024 23 Feb 2024
Institute Indos: 605
PSCRB VI
Sea Explorer's Institute Educational Trust 06 Feb 2024 10 Feb 2024

2
Level Applied:

Signature of
Date Function Candidate
14 Mar 2024 3,4B,5,6 True

Certificate of Competency held, if any:

Certificate Details:
Place of Examination: Date of Examination: --
Class / Grade: Date of Issue: --
If at any time suspended or cancelled, state
Court Authority: Cause:
Date: --

Approved Courses

Remarks
Function / Part Institution From To Stating Grades in
Assessment
Sea Explorer's
ERS OPERATIONAL Institute Educational 15 Feb 2024 17 Feb 2024 PASS
LEVEL
Trust

Declaration:

I hereby declare that the particulars contained in the form are correct and true to the best of my knowledge and
belief and that the papers enumerated and sent with this form are true and genuine documents given and signed
by the person whose name appears on them. I further declare that Section F contains a true and correct account
of sea-going service without exception and I make this declaration conscientiously believing the same to be true.