Seacare Seacare Application Form | SeaCare Pakistan (Private) Limited

SeaCare Pakistan (Private) Limited

Application Form

FORM TO BE FILLED IN CAPITAL LETTERS
Full Name
Image
    City and Country of Birth Nationality as in Passport
Date of birth  
CDC/SSB# Date of Issue/Expire
Passport# Date & Place of Issue
  Valid Until  

Certificate of Competency
Country Grade Cert. No Issued on Valid Until Place of Issue Remarks

List of Valid STCW and Other Courses
Courses
Date of Issue
Courses
date of Issue
Medical First Aid     D.C. Endorsement (Petroleum)
Personal Survical Technique     Advanced Tanker Safety Course
Personal Safety & Social Resp     GMDSS
Ship Captains Medical Guide     Radar Observer/Simulator
Advanced Fire Fighting     S.S.O
Proficieny in Survival craft & Rescue Boat     ISM Familiarization Course
I.G.S     B.T.M
COW     Others 1
ECDIS     Others 2

Record of Last Five Vessels (In Reverse Order)
Vessel
Company
Type
DWT
Eng. Type
BHP
Rank
From
To

Qualification
Academic Qualification
Pre sea Training
Apprenticeship
Others

Continues Record for Rest of the Vessels
Vessel
Company
Type
DWT
Eng. Type
BHP
Rank
From
To
   
Yellow fever Vaccination D.O.E Shipping Office Medical Validity

Personal Data
Name CNIC#
Father Name CNIC#
Mother Name CNIC#
Wife Name CNIC#
Present Address   Permanent Address  
Tel. No Mobile
Email Fax

Details of Children
Name
Date of Birth
Girl
Boy
Remarks

Next of Kin Detail
Next of Kin Name CNIC#
Relationship
Present Address   Permanent Address  
Tel. No. (N.O.K) Mobile No. (N.O.K)

IMPORTANT NOTICE
Please attach two recent photograph along with copies of your CNIC, a copy of CNIC of next of Kin,
photocopies of PASSPORT, CDC and all Certificates.