MMS MARITIME (INDIA) PVT. LTD.
PERSONAL DATA
Surname : GOR Middle Name : KAMLESHBHAI First Name : MANAV
Nationality : Indian Date of Birth : 15-Dec-2003 Place of Birth : GANDHIDHAM, GUJARAT
Post Applied for : Trainee Marine Engineer Willing to accept lower rank ? No Available from Date : 01ST July 2024
Permanent Address : Present Address :
145, MAHAVIR NAGAR, KODAYPUL,MANDVI-KUTCH, GUJARAT, 370460,MANDVI, -
KUTCH,Gujarat,India
PIN Code : 370460 Nearest Airport : PIN Code : -370460
AHMEDABAD
Tel No / Mobile No : - +919512775357 / - +917573826631 Tel No / Mobile No : -
Email ID : manavgor45@[Link]
Document Name Document No. Date of Issue Place of Issue Date of Expiry ECNR Blank Pages Remarks
PASSPORT U6666131 15-Dec-2020 AHMEDABAD 14-Dec-2030 N - NA
SEAMAN BOOK MUM541530 14-Feb-2024 MUMBAI 13-Feb-2034 N - NA
NATIONAL SEAFARERS IDENTITY
CARD
M34575614 06-Mar-2024 MUMBAI 05-Mar-2034 N - NA
PRE-EMPLOYMENT MEDICAL
EXAMINATION (PEME)
TBC 15-Jun-2024 MUMBAI 14-Jun-2026 N - NA
YELLOW FEVER VACCINATION 016030 26-Feb-2024 Mumbai NA N - NA
PSYCHOMETRIC TEST F11062457 12-Jun-2024 MUMBAI NA N - NA
COVID-19 VACCINE COMPLETE
DOSE
45477975177 19-Aug-2022 Mumbai NA N - NA
DCE Capacity Number Date of Issue Place of Issue Date of Expiry
OIL & CHEMICAL BASIC COPDGSOAC24135192 02-JUN-2024 MUMBAI 01-JUN-2029
GAS BASIC NIL NIL NIL NIL
IGF BASIC NIL NIL NIL NIL
Civil Status : Single / Married / Separated/Divorced/Widowed SINGLE
Full Name of Next of Kin : GOR,LAXMIDAS KAMLESH Relationship : FATHER
Address of Next of Kin : MAHAVIR NAGAR, KODAY,370460
Tel No : - 9879690994 / - 9099770330
Family Data Name DOB PPT No. DOI Place of Issue DOE ECNR
FATHER GOR,LAXMIDAS KAMLESH(M) 25-Sep-1978 V3316808 20-OCT-2021 AHMEDABAD 19-OCT-2031 Y
MOTHER GOR,KAMLESH KOMAL(M) 15-Apr-1980 - - - - -
WPIF - 7.5/01 Effective Date: 01-Apr-2022 Rev No: 3
Page 1 of 4
MMS MARITIME (INDIA) PVT. LTD.
Details of Courses & Certificates Number Date of Issue Date of Expiry Place of Issue Issued by
SAFETY, QUALITY & ENVIRONMENT PJB/NH/O/2024/08-MMSI- MMS MARITIME (INDIA) PVT.
MANAGEMENT SYSTEM (SQEMS) 000871
21-Jun-2024 - MUMBAI
LTD.
PJB/NH/O/2024/08-MMSI- MMS MARITIME (INDIA) PVT.
CHARTERER SPECIFIC INFORMATION
000871
20-Jun-2024 - MUMBAI
LTD
INDIAN MARITIME
BASIC SAFETY COURSE WITH PSSR 2050296101230034 04-Jan-2024 - MUMBAI UNIVERSITY- MUMBAI
PORT CAMPUS
PROFICIENCY IN HANDLING FREE-FALL PJB/NH/O/2024/08-MMSI- MMS MARITIME (INDIA) PVT.
LIFEBOAT 000871
20-Jun-2024 - MUMBAI
LTD
INDIAN MARITIME
SEAFARERS WITH DESIGNATED SECURITY
DUTIES AND SECURITY AWARENE
2050296621240034 04-Jan-2024 - MUMBAI UNIVERSITY- MUMBAI
PORT CAMPUS
ASHA INTERNATIONAL
BASIC TRAINING FOR OIL AND CHEMICAL
TANKER CARGO OPERATIONS
2030105111240887 27-May-2024 - MUMBAI INSTITUTE OF MARINE
TECHNOLOGY
ICE/E/2024/06-MMSI- MMS MARITIME (INDIA) PVT.
ICE NAVIGATION COURSE
000871
17-Jun-2024 - Mumbai
LTD.
ENVIRO/O/2024/13- MMS MARITIME (INDIA) PVT.
ENVIRONMENT COMPLIANCE
MMSI-000871
19-Jun-2024 - MUMBAI
LTD.
PJB/NH/O/2024/08-MMSI- MMS MARITIME (INDIA) PVT.
DRUG AND ALCOHOL POLICY
000871
21-Jun-2024 - MUMBAI
LTD
SIRE2.0/O/2024/11- MMS MARITIME (INDIA) PVT.
SIRE 2.0
MMSI-000871
18-Jun-2024 - Mumbai
LTD.
MENTAL WELLBEING PROGRAM MWP-RL/O/2024/13- MMS MARITIME (INDIA) PVT.
(REFLECTIVE LEARNING) MMSI-000871
22-Jun-2024 - MUMBAI
LTD.
10+2 School Details
Name of School/ Institution From To Type of Degree
ARCHANA ST. XAVIER’S SCHOOL, MANDVI-KUTCH 2017 2018 10TH
VEERAYATAN INSTITUTE OF ENGINEERING, KUTCH 2018 2021 DIPLOMA (MECHANICAL ENGINEERING)
Pre Sea Training / Apprentice Ship
Training Institution Place From Date To Date
[Link] MARINE ENGINEERING INDIAN MARITIME MUMBAI 27-SEP-2021 15-MAY-2024
UNIVERSITY- MUMBAI
PORT CAMPUS
MEDICAL HISTORY
(a) Have you ever signed off from a ship due to Medical reasons? (If Yes give details) NO
Name of Vessels Date of Occurrence
NA NA
Brief Description of Illness / Injury / Accident NA
(b) Did you suffer or Are you Presently suffering from any Disease likely to render you unfit for Service at Sea or likely to No
endanger the health of others on board.
(c) Are you addicted to alcohol or drug of any kind? No
(d) Have you suffered from following ? No
Malaria Diabetes Epilepsy Nervous Disability
Previous Sea Service (Date Commencing from Last Vessel)
WPIF - 7.5/01 Effective Date: 01-Apr-2022 Rev No: 3
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MMS MARITIME (INDIA) PVT. LTD.
[Link] Name of Name of Rank Flag Type DWT GRT BHP Engine UMS From To Total Reason for S/OFF
Owners / Vessel Type Y/N MM/DD
Manager
(FOR OFFICE USE ONLY) (INITIAL INTERVIEW (Tick as applicable)
Original licenses sighted [ ] Checked[ ]
STCW and Training Certificates Sighted [ ] Checked[ ]
Experience confirmed by interview Yes [ ] No [ ]
Other details confirmed by interview Yes [ ] No [ ]
A : Dir. & COO: - VG / G / S / P Signature
B : JD / DD: - VG / G / S / P Signature
C : GM:- VG / G / S / P Signature
D: ____ :- VG / G / S / P Signature
WPIF - 7.5/01 Effective Date: 01-Apr-2022 Rev No: 3
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MMS MARITIME (INDIA) PVT. LTD.
Declaration by Seafarer
1) I hereby declare that I have always complied with the company’s drug and alcohol policy in past.
2) I have never been found guilty of not complying with the company’s drug and alcohol policy in any of the previous Companies which I have sailed.
3) I hereby affirm that all the information provided by me in this application is true and correct to the best of my knowledge and belief; further, that no Certificate of
Competency or Licence issued to me has ever been Revoked or Suspended. I also certify that my medical history contained above is True and any false statement or
undisclosed Material information about past illness or injury will disqualify me from any employment benefits and claims.
Date: 01-JUL-2024 Rank: Trainee Marine Engineer Signature of Seaman: MANAV GOR
WPIF - 7.5/01 Effective Date: 01-Apr-2022 Rev No: 3
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