Personal Details. Address Details. Country. Physical Details. Hair Color

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1 Last updated date 17/07/ AM Seafarer Profile Date 17-Jul-2014 Personal Details INDoS No. Name Gender Date of Birth Birth State Nationality 00NL0692 Discipline Nautical RAJEEV JASSAL MALE 09/05/1980 Place of Birth KANGRA HIMACHAL PARDESH Birth Country INDIA INDIAN Address Details Present Address Permanent Address Address FL NO 404, MARIGOLD TOWER Address SECTOR 70, MAYFAIR APPARTMENT MOHALI, SAS NAGAR City Pin State Country Telephone No. MOHALI City Pin Chandigarh State INDIA Country PUNJAB INDIA Telephone No Mobile No Id Height (in Cms) 175 Physical Details Hair Color BLACK Eye Color LIGHT BROWN Complexion FAIR Identification BLACK MOLE BELOW NECK 17/07/ AM Page 1 of 15

Present Address Permanent Address Address FL NO 404, MARIGOLD TOWER Address SECTOR 70, MAYFAIR APPARTMENT MOHALI, SAS NAGAR City Pin State Country Telephone No.

2 Education Details 1. Education Level 10+2 (HSC/Intermediate/equivalent) Main Subjects PHYSICS, CHEMISTRY, MATH, ENGLISH Year of Passing 1997 PCM Mark(%) 83 English Mark(%) 74 Result(%)/Grade Name of University 81 CBSE Name of Institution JNV Institute Address JNV PAPROLA KANGRA HP 2. Education Level Post Graduate Main Subjects MBA Shipping & Logistics Year of Passing 2014 PCM Mark(%) Result(%)/Grade First Name of University London Name of Institution London Institute Address Middlesex University, London English Mark(%) Total no of record in Education Details 2 Pre Sea Training Detail (other) (Date) Pre Sea Tar Book No. Maritime (Mumbai) Pre Sea Training for Deck Cadet 27/04/1998 (Date) 26/07/ Result PASS 1. Modular Course Details Personal Safety & Social Responsibilities Personal Safety & Social Responsibilities Maritime (Mumbai) A-VI/1-4 27/07/ PR /04/ /07/ /07/ AM Page 2 of 15

CBSE Name of Institution JNV Institute Address JNV PAPROLA KANGRA HP 2.

3 Modular Course Details 2. Advance Fire Fighting Advance Fire Fighting TS Chanakya (Navi Mumbai) A-VI/3 14/01/ /01/ /01/ Proficiency in Survival Craft & Rescue Boat Proficiency in Survival Craft & Rescue Boat LBS College of Advanced Maritime Studies (Mumbai) A-VI/2-1 28/01/ /02/ /02/ GMDSS (GOC) GMDSS (GOC) Maritime (Mumbai) 02/12/ /12/ /12/ Radar & Navigation Simulator Course Radar & Navigation Simulator Course LBS College of Advanced Maritime Studies (Mumbai) 20/12/ /12/ /12/ Medical Care Medical Care Applied Research International (New Delhi) A-VI/4-2 03/01/2005 MC /01/ /01/ /07/ AM Page 3 of 15

01/02/2002 4. GMDSS (GOC) GMDSS (GOC) Maritime (Mumbai) 02/12/2002 20/12/2002 8841 20/12/2002 5.

4 7. Modular Course Details Ship Security Officer(SSO) Course Ship Security Officer(SSO) Course Maritime (Mumbai) 31/01/ /02/ /01/ TANKER ADVANCED TRAINING- OIL TANKER ADVANCED TRAINING- OIL Maritime (Mumbai) 21/02/ /03/ /03/ Ship Manoeouring Simulator course Ship Manoeouring Simulator course SAMUNDRA INSTITUTE OF MARITIME STUDIES (MUMBAI) 26/12/ /12/ /12/ Refresher & Revalidation Course for Masters & Deck Officers Refresher & Revalidation Course for Masters & Deck Officers Applied Research International (New Delhi) 04/06/ /06/2012 UG(M)/ /06/2012 Total no of record in Modular Course 10 17/07/ AM Page 4 of 15

Ship Manoeouring Simulator course Ship Manoeouring Simulator course SAMUNDRA INSTITUTE OF MARITIME STUDIES (MUMBAI) 26/12/2006 30/12/2006 9246 30/12/2006 10.

5 1. VISHVA PRAFULLA VISHVA PRAFULLA India 1847 Port of Registry BOMBAY Ship Type Cargo Ship Trade Area Foreign Going Deck Cadet Assistant Officer of Navigational Watch 10/11/1998 Service To (Date) 26/01/ Article Days 17 Propulsion Type Special Category 1. - Assistant Officer of Navigational Watch, 2. MAJOR SHAITAN SINGH PVC MAJOR SHAITAN SINGH PVC India 2061 Port of Registry BOMBAY Ship Type Oil Tanker Trade Area Foreign Going Deck Cadet Assistant Officer of Navigational Watch 13/11/2000 Service To (Date) 11/09/ Article Days 29 Propulsion Type Special Category 1. - Assistant Officer of Navigational Watch, 17/07/ AM Page 5 of 15

MAJOR SHAITAN SINGH PVC MAJOR SHAITAN SINGH PVC India 2061 Port of Registry BOMBAY Ship Type Oil Tanker 37855 Trade Area Foreign Going Deck Cadet Assistant Officer of

6 3. LOKAMANYA TILAK LOKAMANYA TILAK India 1546 Port of Registry MUMBAI Ship Type Oil Tanker Trade Area Foreign Going Second Officer Officer in full charge of Navigational Watch 28/03/2002 Service To (Date) 29/10/ Article Days 3 Propulsion Type 4. PALANIMALAI PALANIMALAI India 2460 Port of Registry MUMBAI Ship Type Chemical Tanker Trade Area Foreign Going Second Officer Officer in full charge of Navigational Watch 17/02/2003 Service To (Date) 03/11/ Article Days 15 Propulsion Type 17/07/ AM Page 6 of 15

PALANIMALAI PALANIMALAI India 2460 Port of Registry MUMBAI Ship Type Chemical Tanker 21035 Trade Area Foreign Going Second Officer

7 5. SAMPURNA SWARAJYA SAMPURNA SWARAJYA India 2739 Port of Registry MUMBAI Ship Type Oil Tanker Trade Area Foreign Going Second Officer Officer in full charge of Navigational Watch 06/12/2003 Service To (Date) 02/03/ Article Days 28 Propulsion Type 6. ANKLESHWAR ANKLESHWAR India 2556 Port of Registry MUMBAI Ship Type Oil Tanker Trade Area Foreign Going Chief Officer Officer in full charge of Navigational Watch 25/03/2005 Service To (Date) 10/01/ Article Days 17 Propulsion Type 17/07/ AM Page 7 of 15

ANKLESHWAR ANKLESHWAR India 2556 Port of Registry MUMBAI Ship Type Oil Tanker 80130 Trade Area Foreign Going Chief Officer Officer in

8 7. JO LIND JO LIND NIS (Norway) Port of Registry BERGEN Ship Type Chemical Tanker Trade Area Foreign Going Chief Officer Officer in full charge of Navigational Watch 25/03/2006 Service To (Date) 26/10/ Article Days 3 Propulsion Type 8. JO CLIPPER JO CLIPPER NIS (Norway) Port of Registry BERGEN Ship Type Chemical Tanker Trade Area Foreign Going Chief Officer Officer in full charge of Navigational Watch 31/12/2006 Service To (Date) 11/02/ Article Days 12 Propulsion Type 17/07/ AM Page 8 of 15

JO CLIPPER JO CLIPPER NIS (Norway) Port of Registry BERGEN 7907611 Ship Type Chemical Tanker 19754 Trade Area Foreign Going Chief

9 9. GEM OF GOA GEM OF GOA NIS (Norway) Port of Registry OSLO Ship Type Chemical Tanker Trade Area Foreign Going Chief Officer Officer in full charge of Navigational Watch 20/07/2007 Service To (Date) 20/11/ Article Days 2 Propulsion Type 1. GEM OF MANGALORE GEM OF MANGALORE NIS (Norway) Port of Registry BERGEN Ship Type Chemical Tanker Trade Area Foreign Going Chief Officer Officer in full charge of Navigational Watch 09/02/2008 Service To (Date) 13/04/ Article Days 4 Propulsion Type 17/07/ AM Page 9 of 15

GEM OF MANGALORE GEM OF MANGALORE NIS (Norway) Port of Registry BERGEN 7907611 Ship Type Chemical Tanker 19754 Trade Area Foreign Going

10 1. URSULA URSULA Singapore Port of Registry SINGAPORE Ship Type Chemical Tanker Trade Area Foreign Going Chief Officer Officer in full charge of Navigational Watch 24/06/2008 Service To (Date) 23/08/ Article Days 0 Propulsion Type 1. GEM OF GOA GEM OF GOA NIS (Norway) Port of Registry OSLO Ship Type Chemical Tanker Trade Area Foreign Going Chief Officer Officer in full charge of Navigational Watch 04/10/2008 Service To (Date) 01/11/ Article Days 29 Propulsion Type 17/07/ AM Page 10 of 15

GEM OF GOA GEM OF GOA NIS (Norway) 7901784 Port of Registry OSLO Ship Type Chemical Tanker 23194 Trade Area Foreign Going Chief

11 1. URSULA URSULA Singapore Port of Registry SINGAPORE Ship Type Chemical Tanker Trade Area Foreign Going Master Officer in full charge of Navigational Watch 25/01/2009 Service To (Date) 03/08/ Article Days 10 Propulsion Type 1. GLOBAL PEACE GLOBAL PEACE Hong Kong HK2478 Port of Registry HONG KONG Ship Type Chemical Tanker Trade Area Foreign Going Master Officer in full charge of Navigational Watch 05/11/2009 Service To (Date) 08/03/ Article Days 4 Propulsion Type 17/07/ AM Page 11 of 15

GLOBAL PEACE GLOBAL PEACE Hong Kong HK2478 Port of Registry HONG KONG Ship Type Chemical Tanker 11623 Trade Area Foreign Going

12 1. GOLDEN BRILLIANCE GOLDEN BRILLIANCE Panama Port of Registry PANAMA Ship Type Chemical Tanker 5979 Trade Area Foreign Going Master Officer in full charge of Navigational Watch 12/08/2010 Service To (Date) 31/01/ Article Days 21 Propulsion Type 1. ROYAL DIAMOND 7 ROYAL DIAMOND 7 Marshall Island 3255 Port of Registry MAJURO Ship Type Chemical Tanker 8539 Trade Area Foreign Going Master Officer in full charge of Navigational Watch 11/05/2011 Service To (Date) 26/09/ Article Days 17 Propulsion Type 17/07/ AM Page 12 of 15

ROYAL DIAMOND 7 ROYAL DIAMOND 7 Marshall Island 3255 Port of Registry MAJURO Ship Type Chemical Tanker 8539 Trade Area Foreign Going

13 1. CHEMBULK HOUSTON CHEMBULK HOUSTON Singapore Port of Registry SINGAPORE Ship Type Chemical Tanker 9230 Trade Area Foreign Going Master Officer in full charge of Navigational Watch 12/01/2012 Service To (Date) 15/04/ Article Days 5 Propulsion Type 1. CHEMBULK GIBRALTAR CHEMBULK GIBRALTAR Singapore Port of Registry Ship Type Chemical Tanker Trade Area Foreign Going Master Officer in full charge of Navigational Watch 22/08/2012 Service To (Date) 08/02/ Article Days 18 Propulsion Type Total no of record in Endorsement GMDSS ENDORSEMENT Certificate of Endorsement Endorsement Type GMDSS ENDORSEMENT Level Operational Issued At NEW DELHI 07/01/2009 (Date) GOC/MMD/DEL /01/ /07/ AM Page 13 of 15

CHEMBULK GIBRALTAR CHEMBULK GIBRALTAR Singapore 393781 Port of Registry 9236054 Ship Type Chemical Tanker 11515 Trade Area Foreign Going Master Officer in full charge of Navigational Watch

14 2. Endorsement DC ENDORSEMENT NAUTICAL Certificate of Endorsement Endorsement Type DC ENDORSEMENT NAUTICAL Level Management Issued At NEW DELHI 15/07/2010 (Date) D/O/2/D/10/ /03/ Endorsement DC ENDORSEMENT NAUTICAL Endorsement Type DC ENDORSEMENT NAUTICAL Level Management Issued At NEW DELHI 15/07/2010 (Date) D/C/2/D/10/ /03/2015 Total no of record in Certificate of Endorsement 3 Certificate of Competency 1. Grade Master of a Foreign Going Ship Grade Master of a Foreign Going Ship Certificate Number IFOO-8701 Certificate Type Issue At NEW DELHI Issuing Country INDIA Place of Examination NOIDA Issue Date 30/07/2007 Certificate delivered 28/01/2008 (Date) 31/12/2016 Suspended/Cancelled Not Applicable By which Authority/Court From Date To Date Cause Total no of record in Certificate of Competency 1 1. Document Type CDC Authorised Documents Document Type CDC Document Number MUM Issued Date 25/03/1999 Issued At Mumbai 17/07/ AM Page 14 of 15

Endorsement 3 Certificate of Competency 1.

15 2. Document Type INDoS Authorised Documents Document Type INDoS Document Number 00NL0692 Issued Date 20/09/ Document Type Passport Document Type Passport Issued At MUMBAI Document Number J Issued Date 16/11/ /11/2021 Issued At CHANDIGARH Total no of record in Authorised Documents 3 DECLARATION TO BE MADE BY CANDIDATE I hereby declare that the particulars entered in the form are correct and true to the best of my knowledge and belief and that the papers enumerated in this form are true and genuine documents given and signed by the person whose names appears on them. I further declare that Seagoing service information entered is a true and correct account of my sea-going service without exception and I make this declaration conscientiously believing the same to be true. The documents in original will be presented to the examiner at the time of taking oral examination or at an earlier time when asked by the department. Signature of the candidate Date This is an electronically generated document hence it does not require any signature of DGS Officials. 17/07/ AM Page 15 of 15

TO BE MADE BY CANDIDATE I hereby declare that the particulars entered in the form are correct and true to the best of my knowledge and belief and that the papers enumerated in this form are true and

APPLICATION FOR EXAMINATION (LEVEL 3 ASSESSMENT) FOR A CERTIFICATE OF COMPETENCY

APPLICATION FOR EXAMINATION (LEVEL 3 ASSESSMENT) FOR A CERTIFICATE OF COMPETENCY ROTATION No : ATTEMPT No : A. PERSONAL PARTICULARS OF APPLICANT SURNAME:... FIRST NAMES:... DATE OF BIRTH:...COUNTRY OF