MARSHAL SHIP MANAGEMENT LTD

APPLICATION FOR EMPLOYMENT

APPLICATION FOR POSITION AS SECOND OFFICER OTHER POSITION (IF ANY) THIRD OFFICER

1. PERSONAL DETAILS
TITLE MR/MRS/MISS MR SEX M
SURNAME NAGURE
FIRST NAME SURAJ MIDDEL NAME SIDHARAM
DATE OF BIRTH 06/02/1992 PLACE OF BIRTH GUHAGAR
NATIONALITY INDIAN MARITAL STATUS SINGLE
COLOUR OF EYES BROWN COLOUR OF HAIR BLACK
MOTHER’S NAME SUJATA NAGURE FATHER’S NAME SIDHARAM NAGURE
SHOESIZE 9 BOILER SUIT SIZE (US) M
HEIGHT (CM) 168 WEIGHT (KG) 68
NEAREST INTERNATIONALAIRPORT: MUMBAI / GOA
INDOS NUMBER 09ZL6591
2. ADDRESS
NO & STREET D71-17, VITHAL KRUPA APT;

CITY SAWANTWADI
POST CODE 416510
COUNTRY INDIA
TEL. NO. 8275861476
MOBILE 9730601490
E-MAIL [email protected]
3. NEXT OF KIN
FULL NAME SUJATA SIDHARAM NAGURE RELATIONSHIP MOTHER
ADDRESS D71-17, VITHAL KRUPA APARTMENT, NEW SABNISWADA, SAWANTWADI
CITY SAWANTWADI COUNTRY INDIA
TEL. NO. 9860241607 MOBILE 9422374239
 MARSHAL SHIP MANAGEMENT LTD
4. CHILDREN
FULL NAME OF CHILD DATE OF SEX
BIRTH
M F
M F

5. TRAVEL DOCUMENTS
TYPE DOCUMENT NO. ISS.DATE EXP. DATE ISS. BY PLACE OF ISSUE
(AUTHORI
TY)
PASSPORT Z5148243 24/10/2018 23/10/2028 GOVT INDIA MUMBAI

SEAMAN BOOK MUM186627 15/04/2011 13/04/2023 GOVT INDIA MUMBAI

OTHER SEAMAN BOOK

US C1/D VISA
OTHER VISAS
6. BANK ACCOUNT INFORMATION
BANK NAME AXIS BANK BRANCH PANVEL
BANK ADDRESS RAJE COMPLEX, PLOT NO.198A, SHIVAJI CHOWK, PANVEL, MAHARASHTRA

BANK SWIFT CODE BANK COUNTRY INDIA

IBAN NUMBER
BENEFICIARY SURAJ SIDHARAM NAGURE

ACCOUNT NUMBER 911010041361867

CURRENCY INDIAN RUPEE

CARD NUMBER/ACCOUNT PASSPORT

7. EDUCATION
INSTITUTE NAME FROM 2017 TO 2018
NEWZEALAND MARITIME SCHOOL
INSTITUTE NAME FROM 2009 TO 2010
SAILORS MARITIME EDUCATION AND TRAINING INSTITUTE

8. PROFESSIONAL QUALIFICATION / CERTIFICATE OF COMPETENCY /WATCH KEEPING /COP

ISSUE EXPIRY ISSUED BY
CERTIFICATE NAME NUMBER ISSUED AT
DATE DATE (AUTHORITY)
MARITIME WELLINGTO
SECOND MATE FG II/1 WKD-16374 28/02/2018 27/02/2023
NEWZEALAND N

TANKER VESSEL CERTIFICATES NUMBER ISSUE DATE EXPIRY DATE

 MARSHAL SHIP MANAGEMENT LTD
OIL 17/2505 22/12/2017
CHEMICAL 17/2505A 22/12/2017
GAS
9. LANGUAGES
FLUENT GOOD FAIR
ENGLISH POOR

ISSUED
MARLIN’S TEST / LEVEL ISSUED DATE RESULT % BY(AUTH ISSUED AT
ORITY)

10. MEDICAL CERTIFICATES & VACCINATIONS

ISSUE
MEDICAL EXPIRY D BY
NUMBER ISSUE DATE ISSUED AT
CERTIFICATES DATE (AUTH
ORITY)
INTERNATIONAL/ILO
PANAMANIAN
YELLOW FEVER YF01/11 30/12/2011 MUMBAI
11. COURSES
ISSUE
EXPIRY D BY
COURSE NAME NUMBER ISSUE DATE ISSUED AT
DATE (AUTH
ORITY)
BPMA/PST-RF/
PERSONAL SURVIVAL/PST 871/2018 06/04/2018 05/04/2023 DG IND INDIA
BPMA/PSSR/
PERSONAL SAFETY AND SOCIAL 2042/2018
14.04.2018 DG IND INDIA
RESPONSIBILITY
BPMA/
FIRE PREVENTION AND FIRE FIGHTING FPFF-RF/ 07.04.2018 DG IND INDIA
738/2018
ADV. FIRE FIGHTING 17/2426 08.12.2017 08.12.2022 MNZ NEWZEALAND
BPMA/E/
ELEMENTARY FIRST AID 1439/2018
11.04.2018 DG IND INDIA

MEDICAL FIRST AID 17/2461 15.12.2017 MNZ NEWZEALAND

MEDICAL CARE MNZ NEWZEALAND

BPMA/PSSR/
PERS. SAFETY & SOC. RESP. 2042/2018 14.04.2018 DG IND INDIA

PROF. IN SURVIVAL CRAFT & RESCUE

17/1406 20.07.2017 20.07.2022 MNZ NEWZEALAND
BOATS
FAST RESCUE CRAFT
 MARSHAL SHIP MANAGEMENT LTD
PREVIOUSE DOCUMENTRY EVALUATION
SECURITY TRAINING FOR SEAFARERS
17/2492 15.12.2017 MNZ NEWZEALAND
WITH DESIGNATED SECURITY DUTIES
SHIP SECURITY OFFICER BPMA/
SSO/ 18.04.2018 DG IND INDIA
316/2018
G.M.D.S.S. GMD-16375 28.02.2018 27.02.2023 MNZ NEWZEALAND

GENERIC ECDIS COURSE 17/1738 22.09.2017 MNZ NEWZEALAND

TYPE SPECIFIC ECDIS COURSE

ROC & ARPA 17/2190 08.11.2017 MNZ NEWZEALAND

RADAR OBSERVATION
HAZMAT
BASIC OIL TANKER 17/2505A 22.12.2017 MNZ NEWZEALAND

ADVANCE OIL TANKER 17/2505 22.12.2017 MNZ NEWZEALAND

BASIC CHEMICAL TANKER 17/2505A 22.12.2017 MNZ NEWZEALAND

ADVANCE OIL TANKER

BASIC GAS TANKER
ADVANCE GAS TANKER
BRIDGE TEAM MANAGEMENT 18/1618 15/12/2017 15/12/2022 MNZ NEWZEALAND
Guidance on value added training MATRIX (Company specific courses)

SHIP MANOUVERING SIMULATOR

ENGINE ROOM SIMULATOR
CARGO HANDLING SIMULATOR COURSE
RISK ASSESSMENT
ISM AWARENESS
BRIDGE AND ENGINE ROOM RESOURCE
MANAGEMENT
ACCIDENT /INCIDENT INVESTIGATION1
SAFETY OFFICER

MARPOL
VAPOUR EMISSION
ENERGY EFFICIENCY
FRAMO3
VETTING4
 MARSHAL SHIP MANAGEMENT LTD
MARITIME ENGLISH
12. ENDORSEMENT
ISSUE
EXPIRY D BY
ENDORSEMENT NAME NUMBER ISSUE DATE ISSUED AT
DATE (AUTH
ORITY)
OIL & CHEM OPERATIONAL WKD-16374 01/03/2018 27/02/2023 MNZ NEWZEALAND
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COMPLETE SEA – SERVICE DETAILS
(LAST VESSELS FIRST )
RANK: AVALIABILITY
NAME: SURAJ SIDHARAM NAGURE SECOND DATE:
OFFICER IMMEDIATE
PERIOD
ENGINE TYPE
SIGNED SIGNED IN TYPE OF D.W.T./
COMPANY NAME RANK VESSEL NAME MONTHS ( ENGINEERS BHP KW
ON OFF VESSEL GRT
ONLY)
2/O 31760
OLYMPOS SHIP BULK
MANAGEMENT MV COURAGE 28/01/2020 29/12/2020 11 M 01 D CARRIER 19805
3/O 16571
BULK
ACA SHIPPING CORP MV ORMI 17/01/2019 29/11/2019 10 M 12 D CARRIER 10299
JR.OFF 2870
TIME LINE SHIP MINI BULK
MANAGEMENT MV KUMAR 01/09/2014 28/04/2015 7 M 28 D CARRIER 1874
DECK 3823
CADET PRODUCT
IPC MARINE SERVICES MT MOHAMMAD 15/01/2012 21/02/2013 13 M 07 D TANKER 2142
 MARSHAL SHIP MANAGEMENT LTD

SECURITY&REFERENCE CHECK CONTACT DETAILS

COMPANY NAME OLYMPOS SHIP MANAGEMENT ACA SHIPPING CORP
ADDRESS PIRAEUS-GREECE PIRAEUS - GREECE
PHONE NO. +306994711701 +306976225255 / +302104294800
FAX/E-MAIL [email protected]
CONTACT PERSON LUAY MALLAH / DPA YANNA ANGELOPOLUS

I declare that the information I have given is, to the best of my knowledge, true and complete. I also declare that the documents submitted are genuine and have
been signed by the person whose name appears on them.

SURAJ SIDHARAM
05/07/2021
NAGURE
DATE SIGNATURE
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