FORM 29
(See Rule 72)
GOVERNMENT OF INDIA
MINISTRY OF PORTS, SHIPPING AND WATERWAYS
DIRECTORATE GENERAL OF SHIPPING
Application for Examination and Assessment for certificates under Merchant
Shipping (Standards of Training, Certification and Watch-keeping for Seafarers)
Application No. : SB/MMD(M)/2024/22237289 Received Date :23/12/2024
A. Grade of Examination : Second Mate of a Foreign Going Ship
Place of Examination : MMD MUMBAI
1. Full Name : SAKSHI KUSHWAHA
(Block letters)
2. Permanent Address : ,Takka Panvel,410206, Raigad,Maharashtra,
SB/MMD(M)/2024/22237289
3. Present Address : Ma-1/ 301, Moraj River Side Parktakka, Panvel, Raigad, Navi Mumbai,Navi
Mumbai,410206 Maharashtra,India
4. Telephone Number : 9969586522
(with STD Code)
5. Nationality : Indian
(Proof to be produced)
6. Passport Number : U3977891
7. Date and Place of Issue : 10/08/2020 At MUMBAI
8. Continuous Discharge : KOL 126974
Certificate (C.D.C)
Number
9. Date and Place of Issue : 18/10/2021 At KOLKATA
10. Date of Birth : 27/02/2003
(Proof to be produced)
[Link] of Birth : KANPUR NAGAR,UTTAR PRADESH
[Link] Identification : MOLE ON LEFT ARM
marks
13. INDos No : 20NM2450
14. Email Id : sakshikv27@[Link]
Note : Any Person who makes, causes to be made or assists in making any false representation for the purpose of obtaining for himself /
B. DETAILS OF SCHOLASTIC EDUCATION :
(Separate sheets must be attached)
[Link] Education Level : 10+2 (HSC/Intermediate/equivalent)
[Link] Subjects : English Core, Hindi, Mathematics, Physics, Chemistry
3. Year of Passing : 2020
4. School/College/ Board : KENDRIYA VIDYALAYA O.N.G.C PANVEL CBSE
5. Address of the Institution : KENDRIYA VIDYALAYA ONGC, PANVEL Phase-I Raigad Dist, PANVEL,
Maharashtra 410221
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C. DETAILS OF PRE-SEA TRAINING / MARINE ENGINEERING WORKSHOP :
(Separate sheet must be attached )
1. Training Institute : TS Rahaman
2. Address of the Institution : SIR MOHAMED YUSUF SEAMEN WELFARE FOUNDATION ,T. S. Rahaman At Post Nhava
Panvel
,410206 tsrahaman@[Link],022-27212800,02227212495
3. Attended From : 16/11/2020 To 19/10/2021
4. Result : pass
5. Courses Attended : Diploma In Nautical Science
D1. DETAILS OF SEA-GOING SERVICE (FOR DECK DEPARTMENT PERSONNEL) :
Port of Trade: Period
Gross
Name of Registry/ NCV/ FG/
Type Tonnage Rank From To Remarks
Ship Official Coastal
Number Months
Days
Special Category : [Link]
SVENDBOR of watch keeping - Assistant
HENNING MAERSK Product Tanker 25710 FG Deck Cadet 26/01/2024 10/07/2024 5 16
G Officer of Navigational
Watch,
Special Category : [Link]
of watch keeping - Assistant
MAERSK CURACAO Product Tanker 29816 Roskilde FG Deck Cadet 25/04/2023 15/12/2023 7 21
Officer of Navigational
Watch,
Special Category : [Link]
SB/MMD(M)/2024/22237289
MAERSK TOKYO Product Tanker 29455 SINGAPOR
E
FG Deck Cadet 17/07/2022 08/01/2023 5 23
of watch keeping - Assistant
Officer of Navigational
Watch,
E-1 REPORT ON STRUCTURED ON-BOARD TRAINING :
Phase No Date Of Name of Master Details Of Certificate Of Competancy
SSTPOC 17/08/2024 T.S RAHAMAN SSTPIMU0230092024
E-2 REPORT OF DESIGNATED COMPANY TRAINING OFFICER :
Signature :
Name : Certificate No. :
E-3 REPORT OF HEAD OF ASSESSMENT CENTRE :
Signature :
Name : Official Stamp :
F. REPORT OF ASSESSMENT CENTRE :
POST-SEA APPROVED EDUCATION AND TRAINING AT APPROVED INSTITUTION LEVEL
2M(Operational)/1M&M(Management)
Function /Part Institution From To Remarks
MASSA Maritime Academy 15-AUG-2024 14-DEC-2024
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F-2 REMARKS OF HEAD OF ASSESSMENT CENTRE :
ELIGIBILTY FOR OPERATIONAL/MANAGEMENT LEVEL(Phase I & II)
ELIGIBILITY FOR WRITTEN FUNCTION I/II/III/ASM
ELIGIBILTY FOR ORALS FUNCTION I/II/III/ASM
* Online application may be provisionally approved subject to verification of Originals during Orals
Signature :
Name : Official Stamp :
G. PARTICULARS OF STCW CONVENTIONS MODULAR COURSES (POST-SEA) :
STCW Reg. / Period
Sr. Validity
Courses STCW Code Cert. No. Approved Institution
No.
No From To
1 General Operator`s Certificate for GMDSS 2010044211250086 TS Rahaman 07-APR-2025 19-APR-2025
Electronic Chart Display and Information
2 2070422123250013 MASSA Maritime Academy 03-FEB-2025 07-FEB-2025
Systems
3 Automatic Radar Plotting Aids A-II/1 2070422122250017 MASSA Maritime Academy 27-JAN-2025 31-JAN-2025
5 SB/MMD(M)/2024/22237289
Radar Observer Simulator
Proficiency In Survival Craft and Rescue
Boats
A-II/1
A-VI/2-1
2070422121250029
2010046211240299
MASSA Maritime Academy
TS Rahaman
13-JAN-2025
29-JUL-2024
24-JAN-2025
02-AUG-2024
6 Advanced Training in Fire Fighting A-VI/3 2010046311240278 TS Rahaman 22-JUL-2024 26-JUL-2024
7 Fire Prevention & Fire Fighting A-VI/1-2 2010046311240278 TS Rahaman 22-JUL-2024 26-JUL-2024
8 Medical First Aid A-VI/4-1 2010046411240286 TS Rahaman 17-JUL-2024 20-JUL-2024
9 Elementary First Aid A-VI/1-3 20100461012102515 TS Rahaman 30-MAR-2022 31-MAR-2022
10 Personal Survival Techniques A-VI/1-1 20100461012102515 TS Rahaman 30-MAR-2022 31-MAR-2022
Basic Training for Liquified Gas Tanker Cargo
11 40201051212103214 HIMT College 28-DEC-2021 01-JAN-2022
Operations
Basic Training for Oil and Chemical Tanker
12 40301951112102711 HIMT Tidal Park 22-NOV-2021 29-NOV-2021
Cargo Operations
13 Personal Safety & Social Responsibilities A-VI/1-4 20100461012102515 TS Rahaman 21-SEP-2021 31-MAR-2022
Security Trng. for Seafarer with Designated
14 20100466212101715 TS Rahaman 20-SEP-2021 22-SEP-2021
Security Duties
H. PREVIOUS CERTIFICATE ( Issued in India or elsewhere, If none state so) :
If any time suspended or cancelled, state
Place & date of Examination
Number Certificate
Class /Grade
Details Examination Issue Date
Court of Authority
Date Cause
I. DECLARATION TO BE MADE BY THE CANDIDATE :
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 D contains a true and correct account of my sea-going service
without exception and I make this declaration conscientiously believing the
SAKSHI KUSHWAHA The above declaration was signed in my presence.
Signature of the candidate
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SAKSHI KUSHWAHA
Examiner of Masters and Mates
Mercantile Marine Department.........................District
J. REQUEST FOR ALLOTMENT OF SEATS FOR EXAMINATION :
Sign of
Sign of
Fees Paid Written Papers Orals Candidate
Examiner
Applied
Month Grade
for
Referance No CARGO CARGO/
Amount NAV1 NAV2 NAV3 NAV4
/ ASM
SOF1 SOF2 NAV
ASM
SOF
& Date
YAX624998386
MMD SECOND
JAN-2025
MATE
3000 42 23/12/2024 Y Y Y Y Y Y
MUMBAI
YAX625348537
MMD
SB/MMD(M)/2024/22237289
MAR-2025 SECOND
MATE
2000 52 25/02/2025 Y Y Y
MUMBAI
YAX625629644
MMD MAY-2025 SECOND
MATE
3000 45 24/04/2025 Y Y Y
MUMBAI
YAX625687489
MMD SECOND
JUN-2025
MATE
1000 63 07/05/2025 Y
MUMBAI
YAX625893933
MMD SECOND
JUL-2025
MATE
1000 99 24/06/2025 Y
MUMBAI
YAX626010320
MMD AUG-2025 SECOND
MATE
1000 90 22/07/2025 Y
MUMBAI
K 1. Sight Test :Date of Examination : _________________Result _____________Signature of Examiner
K 2. RESULT OF EXAMINATION :( for official purpose only) :
Name of Examiner
No. Written Papers Orals Signal
of O : Oral , W :Written
Atte Month Grade
mpts CARGO/ CARGO/
NAV1 NAV2 NAV3 NAV4 SOF1 SOF2 NAV SOF
ASM ASM
SECOND
1 JAN-2025 FAIL FAIL PASS PASS FAIL FAIL
MATE
MAR-2025 SECOND
2 PASS PASS PASS
MATE
[Link] Sunil Topno
MAY-2025 SECOND
3 FAIL PASS PASS
MATE
O-Capt. N. Mukesh
SECOND
4 JUN-2025 FAIL
MATE
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Name of Examiner
No. Written Papers Orals Signal
of O : Oral , W :Written
Atte Month Grade
mpts CARGO/ CARGO/
NAV1 NAV2 NAV3 NAV4 SOF1 SOF2 NAV SOF
ASM ASM
SECOND
5 JUL-2025 PASS
MATE
O-Capt. Hemant Jarwal
AUG-2025 SECOND
6 PASS
MATE
Note :
Second Mate (FG) / NWKO-NCV : NAV 1: Terrestrial and coastal Navigation, NAV 2: Celestial Navigation, NAV 3: Meteorology, NAV 4: Bridge Watch Keeping and Emergencies.
First Mate (FG / NCV ): Phase I: NAV 1:Terrestrial and coastal Navigation. NAV 2: Meteorology, SOF 1: Ship Safety, Damage Control and Management of Personnel, SOF 2: Naval
Architecture Paper I.
First Mate (FG / NCV ) Phase II: NAV 1: Navigation AIds Including compasses, NAV 2: Bridge Watch Keeping . Ship Handling and Emergencies , NAV 3: Engineering Knowledge ,
Instruments and Control Systems , SOF 1: Naval Architecture Paper II, SOF 2: Marine Legislatoin .
L. REPORT OF EXAMINATION CENTRE
1. I hereby certify that Kushwaha Sakshi has satisfactory produced testimonials and proof of sea-going
service/watch keeping service/approved workshop training as required for the grade.
SB/MMD(M)/2024/22237289
2. The candidate complies with the examination of the Merchant Shipping Standards (Standards of Training
Certification and Watch-keeping for Seafarers) Rules, 1998 for the grade of Second Mate of a Foreign Going
Ship
3. The candidate has passed his examinations for the functions as under :
Function
Phase Level
Written Written Examiner Oral Oral Examiner
MAR-2025 MAY-2025
CARGO Assessment officer [Link] Sunil Topno
MMD MUMBAI MMD MUMBAI
JUL-2025 MAY-2025
SHIP OPERATION Assessment officer [Link] Sunil Topno
MMD MUMBAI MMD MUMBAI
M. FOR THE CHIEF EXAMINER OF MASTERS AND MASTES
1. I hereby certify that Kushwaha Sakshi born at Kanpur Nagar,Uttar Pradesh on 27.02.2003 has satisfactory produced
his testimonials and proof of Sea-going Service/Watch Keeping Service.
2. The candidate complies with the Merchant Shipping (Standards of Training Certification and Watch-keeping for
Seafarers) Rules, 1998 for the grade of Second Mate of a Foreign Going Ship
3. The candidate has passed the examination of the functions as under :
Phase Level Function Sign. of Examiner with Remarks
Written Oral
MAR-2025 MAY-2025
CARGO
MMD MUMBAI MMD MUMBAI
JUL-2025 MAY-2025
SHIP OPERATION
MMD MUMBAI MMD MUMBAI
The candidate meets the requirements be eligible to be issued the Certificate of Competency as ...............................................
provisional certificate issued No.................................................................... on....................................................................
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Examiner of Masters and Mates
Mercantile Marine Department
N. FINAL ASSESSMENT PRIOR CERTIFICATION
Medical Fitness
Pre-Sea Training Complied
Structured on Board Training N/A
Sea-Service Requirement Complied
Written Examination (Assessment) Yes
Oral Assessment Yes
Modular Courses Complied
Eligibility Yes
Certificate for Competency Second Mate of a Foreign Going Ship as recommended by Mercantile Marine Department may be issued.
Assessor at Directorate General of Shipping for Masters and Mates.
Remarks_____________________________________________________________________
Chief Examiner
(Masters and Mates)
SB/MMD(M)/2024/22237289
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