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MSC CREWING SERVICES PRIVATE LIMITED

APPLICATION FORM
1 Position ID/PD No. (For Office Use Only)
_______________________
Position applied for: 3/E
Are you willing to accept any other positions? If YES, which positions would you consider? NO

Are you responding to a media advertisement? If YES, please state which publication NO

From what date will you be available? 02/10/23

2 Personal details
Name: (Surname) PANDA
(First Names) BHANU
(Middle Name) SHANKAR
Date/Place of Birth: 25-11-1973/BRAHMAPUR Nationality: INDIAN
Permanent address: MG-28,MARELLA GARDEN GIRI ROAD,BRAHMAPUR
Pin Code: 760005
E-Mail: bhanuspanda@gmail. Tel No. : Mobile 7788005617
com
Local address: same
Pin Code:
E-Mail: Tel No. Mobile

3a Educational Background
Qualification School / College From To Percentage/ Grade
10th Standard St.Vincenrs convent school 1980 1989 63
10+2(Science) Khallikote college 61

3b Technical Background
Degree/ Diploma Institute/ College From To Percentage / Grade
B.TECH(Mechanical) DSCE 1997 2001 62
GME Cochin Shipyard Ltd. 2002 2003 79

4 Identity documents
DOCUMENT COUNTRY NUMBER DATE OF ISSUE PLACE OF ISSUE DATE OF EXPIRY
Passport: INDIAN P2999287 23/05/16 BHUBANESWAR 22/05/26
Seaman Book: National CH20075 08/11/15 CHENNAI 07/11/25
Panamanian
Liberian
Others
Do you hold a US Visa ‘C1/D’? YES/NO Issue Date: Expiry Date:
Do you hold a US Visa ‘B1/B2’? YES/NO Issue Date: Expiry Date:
Have you been rejected for any visa applied for? NO
If YES, please state the country and reasons
INDOS No: (only for Indians) 01EL5462 YELLOW FEWER -NO 18954 -08/03/2019 V/T
MUI NO : V/T

5 Family Details: (If Unmarried kindly give details of Father / Mother)

NAME PASSPORT PLACE OF DATE OF DATE OF
Relation DOB POB ECNR
NO. ISSUE ISSUE EXPIRY
Debjani Panda Wife 14/09/ brahmapu
Dhiv Panda Son 77777 brahmapu
09/03/ r
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6 Certificates (Highest certificate of competency held)
Grade/Class Date of Passing Certificate
Issuing Country Date Issued Place Issued Valid Until
Of COC Exam No.
Country
CLASS INDIA 02/05/06 95Z-6382 29/10/2021 MMD,KOLKA 20/10/2026
IVPART “B” TATS
7 Certificates Of Competency issued by other countries (Issued by countries other than in Section 6)
Issuing Country Certificate No. Date Issued Place Issued Valid Until
Panama
Others
8 Details of Courses
Courses Certificate No. Issued By Date Issued Date Of Expiry
FPFF / AFF 40201063122301212 HIMT,CHN 22/02/23 21/02/28
EFA / MFA / MEDICARE 20301016819103 I
AIIMT,MU 11/03/19 10/03/24
PSCRB 40201062122301410 M
HIMT,CHN 22/02/23 21/02/28
PST PST/002213 UMTA,KO 19/12/02 21/12/02
PSSR – Personal Safety & Social Responsibilities SCMS2/PSSR/221/17 CHI
SCMS,MU 13/05/17 NA
SSO – Ship Security Officers Course SSO0031400009 M13/05/17
MMA,KOL 08/01/14 NA
ISPS Course KATA
ROSC – Radar OBS Simulator
ARPA – Automatic Radar Plotting Aid
RANSCO – Radar, Arpa & Navigation Simulator
BTM
SMS / SHS / ERS
ECDIS
Bridge / Engine Resources Management (BRM / ERM)
Ship Master Command and Control Course
GMDSS + endorsement
RUTC – Refresher & Up gradation Course
Container Operations Familiarization
Electrical Familiarization for Marine Engineers
Electronics for Marine Engineers
Instrumentation & Shipboard Control Systems
Automation and Controls
Container Refrigeration
Hydraulics for Engineers (Basic / Advance)
Hazmat (In compliance with STCW-95 Section-B -V/b & V/c & CFR – 49)
CFR-49 and Pneumatics Workshop
Hydraulics
Watch Keeping Certificate Ratings (Deck/Engine)
Applied Electronics (AELC)
Practical Marine Electrical Workshop
Engine Equipment Maintenance Workshop
Basic Electrical and Fluid Technology
Reefer Container and Maintenance Course
MEPC
Operational competence enhancement course for deck
officers
Safety, Environment Compliance & Pollution Prevention
Training for Crew
Vessel Resource Management (VRM)
Electro Technical Officer/ Rating Certificate

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 9 Record of previous service
(Please give a full record starting with the last vessel on which you served)

VESSEL D.W.T/ CONTS VSL TYPE OF ENGINES SIGN ON SIGN OFF DURATION REASONS FOR
COMPANY VESSEL NAME B.H.P RANK
TYPE GRT TEU’S AGE (Please give full dtls) dd/mm/yy dd/mm/yy yy/mm/dd S/OFF

Transworld SSL BHARAT CONT 29383 4500 28 MAN B&W 30560 3/E 04/04/23 18/06/23 00/02/15 Mother expired
Shipping
SU NAV SUBARNAREKH .B/C 40002 19 MAN B&W 8560 3/E 04/07/22 26/12/22 00/05/23 CC
SU NAV A
ASPEN B/C 30250 12 MAN 9860 3/E 10/11/21 18/04/22 00/05/20 CC
ASWAN Shipping ULA B/C 22580 29 SULZER RTA 9890 3/E 28/10/19 04/06/21 01/07/03 CC
Khalid Faraz FAZAH B/C 7000 22 MAK/4-Stroke 5500 3/E 13/05/19 10/06/19 00/01/00 Short Contract
Shipping
Iskenderun NIHAT-M B/C 53300 13 Hitachi B&W 9800 3/E 17/05/17 28/12/17 00/06/12 CC
PIL KOTA TERAJU CONT 76738 6000 17 MAN B&W 12400 3/E 14/01/16 27/02/16 00/01/14 Father expired
AESM SAM LION .B/C 57200 8 MAN B&W 9480 3/E 25/04/14 09/12/14 00/07/14 CC
AESM SAM LION B/C 57200 8 MAN B&W 9480 3/E 23/04/13 11/11/13 00/06/18 CC
BSM HALO CYGNUS B/C 73957 13 SULZER 12100 3/E 05/05/12 08/08/12 00/03/03 Father serious
AESM GOLDEN EAGLE B/C 50317 1 RTFLEX 8890 3/E 11/12/10 05/06/11 00/05/25 CC
FML TRITON B/C 63151 0 MAN B&W 13900 3/E 05/06/09 16/12/09 00/06/12 CC
FML BULKER
SATURNUS B/C 47242 0 STX MAN 12900 3/E 15/08/08 11/03/09 00/06/26 CC
FML RAINBOW B/C 39667 12 SULZER RTA Series 11000 4/E 07/09/07 08/04/08 00/07/01 CC
United Ocean KS MERCURY B/C 56044 14 Hitachi B&W 11550 4/E 20/12/06 21/04/07 00/04/01 Short Contract
Crowley Accord ORISSA B/C 66478 29 GMT-FIAT 20300 5/E 06/11/03 14/07/04 00/08/09 CC

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10 For Engineers (Please provide details)

Generators STX,DAIHATSU,YANMAR,MAN.

Purifiers and Boilers

MITSUBISHI,ALFA LAVAL.ALCAP&AALBORG,VOLCANO

Type of Cranes / No of
ELECTO-HYDRAULIC CRANES
Reefer Containers

11 Sailing Experience: (Please advise PRESENT RANK EXPERIENCE on each type of vessel)

Container PCC Reefer Multi Purpose Others

4 MONTHS 72 Months BULK CARRIER

LAST SALARY DRAWN (PLEASE MENTION CURRENCY) 4000$

12 Medical history
Have you ever signed off a ship due to medical reasons? YES/NO NO
Have you undergone any operation in the past? YES/NO NO
Have you consulted a doctor during the last 12 months for an illness/accident? YES/NO NO
Do you have any health or disability problems now? YES/NO NO

(If the answer is YES to any of the above, please give full details and attach a separate page if necessary)

13 General
Have you ever been the subject of a court of enquiry or involved in a maritime accident? YES/NO NO
Have you ever had a professional license suspended or revoked? YES/NO NO

(If YES, please give full details and attach a separate page if necessary)

14 References (Please give the name and address of your current or immediate past employer)
Name of company 1. 2. SU NBAV SHIPPING
Name of person to contact VINAYAK GUPTA
Address CHENNAI

 No. 04446878999

15 Review
If immediate employment is not available do you wish to be considered for future vacancies? YES
If YES, please give any alternative contact details not shown in Section 2 9853046604

16 Declaration

I hereby declare that the above particulars are true and authorise you to contact the referees listed above.
Date: 01/09/2023

Signature
17 BOILER SUIT SIZE: XL SAFETY SHOE SIZE:8

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