Kuwait Oil Tanker Company S.A.K.

OM 4.3.1

Application Form
Please use additional sheets if required

Personal Details

Rank Applied For: CHIEF ENGINEER

Name: first
RAJIV RANJAN PRASAD

Agency:
middle

family

Address: H NO. 56A,ZONE 1,BIRSANAGAR(NEAR GUPTA GAS

AGENCY)JAMSHEDPUR-831019
Email: ce.rajiv@outlook.com

Tel:

Mobile:8603871886
Nationality:INDIAN

Other:
Religion:HINDU

Date of Birth: 20/10/1974

Photo

Place of Birth: PATNA

Family Details

Married: No
Yes
If yes, Wifes Name:PURNIMA MAHATO
Married:29/04/2006
Wifes Place / DOB:JAMSHEDPUR/15/08/1976
No:J2192994
Date Issued: 26/07/10

Place Issued:RANCHI

Date
Wifes PP

Date Expires:25/07/20

No. of Children:02
Please give their names and dates of birth.
Name
DOB
3.
1. SIDDHARTH PRASAD
21/02/2007
4.
2. ARCHISHA PRASAD
17/07/2014
5.
Full Name of Next of Kin: PURNIMA MAHATO
Relationship: WIFE
Address: H NO. 56A,ZONE 1,BIRSANAGAR(NEAR GUPTA GAS AGENCY)JAMSHEDPUR-831019
Tel:
punuarchery@gmail.com

Number
K5100482
CL73805

Max. Unrestricted Grade

CLASS 1

Date Issued
19/07/2012
25/02/00

Date Expires
18/07/2022
30/01/2025

Place/ Country Issued

KOLKATA/INDIA

Date Issued
12/03/08

Date expires
31/12/2016

Place/ Country Issued

KOLKATA/INDIA

Date Issued
22/09/2014

Date expires
31/12/2016

Tanker Endorsements (DCE)

Level

Oil
Gas
Chemical

Place/ Country Issued

RANCHI/INDIA
KOLKATA/INDIA

Certificate of Competency

C of C
GMDSS-GOC
-ROC

Email:

Document Details

Document
National Passport
Seamans Book
C of C State Med

Mobile:9472712271

Qualifications (General & Professional)

From

To

Qualification

Subjects

1997

1998

PG DIPLOMA

THERMAL POWER

1992

1996

B.E

MECHANICAL

Rev. 00

Date: 01 Mar 09

Retention Period: Indefinite

College
NATIONAL
POWER
TRAINING
INSTITUTE
BIRLA
INSTITUTE OF
TECHNOLOGY

Place
NEW
DELHI
RANCHI

Page 1 of 3

Kuwait Oil Tanker Company S.A.K.

OM 4.3.1

Additional
Skills

Computer Proficiency (Word,

Excel)
Language, specify

Short Training Courses Attended

Shipboard Safety Officer

Place of
Issue

Ship Security Officer

MUMBAI

Bridge Team Management

Advanced Oil Tanker Course

ECDIS

Advanced Gas Tanker Course

Ship Handling Simulator

Prof. Surv.craft / fast rescue boats

Risk Assessment & accident investig.

Liquid Cargo Simulator course
Liquid Gas Simulator Course
Pers. in charge of Med Care

LUCKNO
W

25/03/1
3

Course

Adv Fire Fighting / SBFF

Date of
Issue

30/03/2
013

Oil Tanker Familiarization

Place of
Issue

Date of
Issue

Gas Tanker Familiarization

KOLKAT
A

LUCKNO
W

15/01/0
5

26/03/1
3

Course (please specify)

Sea Service Record for Last 5 Years (Last Service First)

Period
From
To
2129-JANOCT-14
15
22-JAN- 2614
APR-14

Rank

C of C

C/E

CLAS
S1
CLAS
S1

C/E

DCE
level
2

Name
NEW GLOBE

Vessel
Type
VLCC

DWT
297068

SHINYO
KIERAN

VLCC

297068

CLAS
S1
CLAS
S1
CLAS
S1

SHINYO
OCEAN
SHINYO
OCEAN
ETERNAL
DILIGENCE

VLCC

281395

VLCC

281395

OIL
TANK
ER

74994

19-MAY13
24-SEP12
4-MAR11

15-SEP13
21-JAN13
26-JUL11

C/E

25-Feb10

13-Aug10

C/E

CLAS
S1

MAHARAJA
AGRASEN

OIL
TANK
ER

7-Jan09

12-Aug09

C/E

CLAS
S1

N.JADUNATH
SING PVC

31-May08

5-Sep08

C/E

CLAS
S1

MAHARSHI
KARVE

19-Jul06

10-May07

2/E

CLAS
S2

GANDHAR

1-Apr05

18-Jan06

2/E

CLAS
S2

VARANASI

14-Jun03

03-jan04

4/E

CLAS
S4

VIVEKANAND
A

29-Oct02

7-May03

4/E

CLAS
S4

H.ABDUL
HAMID PVC

19-Mar00

30-Mar01

5/E

EXN
45

GURU
GOBIND
SINGH

Rev. 00

Date: 01 Mar 09

C/E
C/E

2
2

Main Engine
Name
HP
MAN
34169
B&W
MAN
34169
B&W

Company
UNIVAN
UNIVAN

SULZE
R
SULZE
R
MAN
B&W

30391

UNIVAN

30391

UNIVAN

16641

MMS CO.
LTD

144000

MAN
B&W

19100

SCI LTD

OIL
TANK
ER

77000

SULZE
R

9520

SCI LTD

OIL
TANK
ER
OIL
TANK
ER
BULK
CAR
RIER
OIL
TANK
ER
OIL
TANK
ER
OIL
TANK
ER

123000

SULZE
R

27300

SCI LTD

144000

MAN
B&W

19100

SCI LTD

47351

MAN
B&W

10800

SCI LTD

77000

SULZE
R

20300

SCI LTD

77000

SULZE
R

9520

SCI LTD

144000

MAN
B&W

19100

SCI LTD

Retention Period: Indefinite

Page 2 of 3

Kuwait Oil Tanker Company S.A.K.

Shore Service: Period: 1996-1997

OM 4.3.1

Position:ENGINEER

Nature of Employment:PERMANENT

Employer:LML LTD

Additional Information

Have you ever been in a ship involved in an accident?

Yes

Yes

If yes, when, and in what capacity were you serving at the time?
Was a court of Enquiry held, were you held in any way to blame?

Has your Certificate ever been suspended?

If yes, state dates of suspension?

No

No

From:

to:

10 Reasons for Application

State why you wish to leave your present employment.

FOR BETTER EMPLOYEMENT CONDITION

You may add here anything further you wish to in support

of your application.

HARD WORKING,FOLLOWING COMPANY POLICY

May we approach your present employer for a reference?

If yes, give contact details:
What notice do you require to attend an interview?
What date are you available for sea service?

Yes

No

3-4 DAYS
APRIL 15TH 2015

I declare that the information provided here is true as on the date.

I have attached copies of all the documents supporting information in blocks 2 to 8 inclusive .

Applicants Signature: _________________ Date:

Send to:

Rev. 00

Date: 01 Mar 09

Agency Signature: ________________

Copy to:

Retention Period: Indefinite

Page 3 of 3