FORM 29

(See Rule 72)

GOVERNMENT OF INDIA
MINISTRY OF SURFACE TRANSPORT
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(KO)/2011/22222935

A. Grade of Examination
Place of Examination

Received Date :21/09/2011

: First Mate of a Foreign Going Ship

: MMD KOLKATA

1. Full Name
(Block letters)

: PRAVEEN SHANKAR

2. Permanent Address

: ,

SB/MMD(KO)/2011/22222935

3. Present Address

: Shyamnagarmaurya Path,Khajepura,Po:B.V College,Patna,800014 Bihar,India

4. Telephone Number
(with STD Code)
5. Nationality
(Proof to be produced)

6. Passport Number

: E 1386245

7. Date and Place of Issue

: 15/01/2003 At PATNA

8. Continuous Discharge
Certificate (C.D.C)
Number

: MUM 109629

9. Date and Place of Issue

10. Date of Birth
(Proof to be produced)

: 04/03/2003 At Mumbai

11.Place of Birth

: JAHANABAD(BIHAR)

12.Personal Identification
marks

: MOLE ON LEFT WRIST

13. INDos No

: 01NL2239

14. Email Id

: praveenshankara@yahoo.com

: INDIAN

: 21/08/1983

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)
1.Scholastic Education Level

: 10+2 (HSC/Intermediate/equivalent)

2.Principal Subjects

: Pcme

3. Year of Passing

: 2002

4. School/College/ Board

: A.P.COLLEGE NADAUL PATNA BIHAR INTERMEDIATE COUNCIL

5. Address of the Institution

: BIHAR INTERMEDIATE COUNCIL PATNA BIHAR

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C. DETAILS OF PRE-SEA TRAINING / MARINE ENGINEERING WORKSHOP :

(Separate sheet must be attached )
1. Training Institute

: TS Chanakya

2. Address of the Institution

: VILLAGE:KARAVE, ,NERUL
,400 706 TSCHANAKYA@HOTMAIL.COM,022-27701315,7700398

3. Attended From

: 02/09/2002 To 12/12/2002

4. Result

: PASS

5. Courses Attended

: Pre Sea Training for Deck Cadet

D1. DETAILS OF SEA-GOING SERVICE (FOR DECK DEPARTMENT PERSONNEL) :

Name of
Ship

Port of
Trade:
Gross
Registry/ NCV/ FG/
Tonnage
Official
Coastal
Number

Type

Period
Rank

From

To

Remarks
Months

Days

MV SPAR VEGA

Bulk Carrier

32839

BERGEN

FG

Second Officer

23/01/2014

08/07/2014

17

MV SPAR TAURUS

Bulk Carrier

32474

BERGEN

FG

Second Officer

30/01/2013

29/05/2013

M.T.HIGH FORCE

Oil Tanker

31433

PANAMA

FG

Second Officer

10/12/2011

20/07/2012

12

09/11/2010

31/03/2011

23

07/01/2010

02/06/2010

27

Chemical Tanker

M.T.VEGA SPRING

15042

PANAMA

FG

11571

HONG
KONG

FG

Watch Keeping
Deck Officer
OINW / Third
officer
Watch Keeping
Deck Officer
OINW / Third
officer

SB/MMD(KO)/2011/22222935
Chemical Tanker

M.T. BUM EUN

M.V.BELGIAN
EXPRESS

Container Ship

11571

MAJURO

FG

Deck Cadet

04/01/2006

20/12/2006

11

18

M.V.SPAR TWO

Bulk Carrier

22258

PANAMA

FG

Deck Cadet

22/10/2004

31/10/2005

12

11

6301

MAJURO

FG

Deck Cadet

24/09/2004

21/10/2004

28

Chemical Tanker

M.T.PANAM FLOTA

Special Category : 1.Nature

of watch keeping - Assistant
Officer of Navigational
Watch,
Special Category : 1.Nature
of watch keeping - Assistant
Officer of Navigational
Watch,
Special Category : 1.Nature
of watch keeping - Assistant
Officer of Navigational
Watch,

E-1 REPORT ON STRUCTURED ON-BOARD TRAINING :

Phase No
SSTPOC

Date Of
02/07/2007

Name of Master

Details Of Certificate Of Competancy

ARI

ARI/SSTP/099/07

E-2 REPORT OF DESIGNATED COMPANY TRAINING OFFICER :

Signature :

Name

Certificate No. :

E-3 REPORT OF HEAD OF ASSESSMENT CENTRE :

Signature :
Name

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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

PHASE1

Indian Institute of Port Management (IMU Kolkata)

15-JUN-2011

14-SEP-2011

PHASE2

INSTITUTE OF MARINE EDUCATION & RESEARCH

15-OCT-2014

14-JAN-2015

Remarks

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) :

Sr.
No.

SB/MMD(KO)/2011/22222935
Courses

STCW Reg. /
STCW Code
No

Period

Cert. No.

Approved Institution

From

To

SMC/RANSCO/1695 Seacom Marine College

16-FEB-2015

21-FEB-2015

IMER
INSTITUTE OF MARINE
MEDICARE/229/2013 EDUCATION & RESEARCH

04-NOV-2013

15-NOV-2013

Radar & Navigation Simulator Course

Medical Care

Simulator- Liquid Cargo Handling-Oil-Mgmt

Level

LCH/26/09/180

MASSA Maritime Academy

07-DEC-2009

11-DEC-2009

Tanker Advanced Training- Chemical

STC/06/09/133

MASSA Maritime Academy

16-NOV-2009

27-NOV-2009

TANKER ADVANCED TRAINING- OIL

07-SEP-2009

19-SEP-2009

Medical First Aid

BP Marine Academy

29-JUL-2008

01-AUG-2008

MASSA Maritime Academy

12-MAY-2008

16-MAY-2008

TS Chanakya

07-APR-2008

12-APR-2008

MASSA Maritime Academy

04-FEB-2008

15-FEB-2008

TS Chanakya

08-OCT-2007

20-OCT-2007

27-AUG-2007

31-AUG-2007

16-APR-2007

14-AUG-2007

23-AUG-2004

27-AUG-2004

A-VI/4-2

MMTI/STPOTO/1317/20 Mumbai Maritime Training Institute

09
A-VI/4-1

BPMA/M/231/2008

Automatic Radar Plotting Aids

A-II/1

ARP/07/08/056

Advance Fire Fighting

A-VI/3

3761

Radar Observer Simulator Course

A-II/1

ROC/02/08/010

10

GMDSS (GOC)

11

Proficiency in Survival Craft & Rescue Boat

12

SECOND MATE FG LIMITED

13

Tanker Familiarsation- Liquified Gas

14

Tanker Familiarization- Chemical

CTF/09/04/090

MASSA Maritime Academy

16-AUG-2004

20-AUG-2004

15

Tanker Familiarization- Oil

NJ/00608/2651

United Marine Academy

03-FEB-2003

07-FEB-2003

16

Personal Safety & Social Responsibilities

A-VI/1-4

NV/06802/5655

United Marine Academy

05-DEC-2002

07-DEC-2002

17

Elementary First Aid

A-VI/1-3

PS/09502/4752

United Marine Academy

02-DEC-2002

03-DEC-2002

18

Fire Prevention & Fire Fighting

A-VI/1-2

0710

TS Chanakya

31-OCT-2002

02-NOV-2002

GOC-M-0313
A-VI/2-1

BPMA/PSCRB/1520/200
BP Marine Academy
7
2MF/02/07/044

MASSA Maritime Academy

BPMA/LGT/569/2004 BP Marine Academy

Validity

25-OCT-2017

H. PREVIOUS CERTIFICATE ( Issued in India or elsewhere, If none state so) :

Number

Generated on

Certificate
Details

Place & date of Examination

Class /Grade

: 19/12/2015 12.46 PM

Examination

Issue Date

If any time suspended or cancelled, state

Court of Authority

Date

Cause
Page 3 of 7

Second Mate of a Foreign Going

Ship

IF-21959

MUMBAI

17-SEP-2009

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
PRAVEEN SHANKAR

The above declaration was signed in my presence.

Signature of the candidate

Examiner of Masters and Mates

Mercantile Marine Department.........................District

J. REQUEST FOR ALLOTMENT OF SEATS FOR EXAMINATION :

Fees Paid
Applied
for

Month

Written Papers

Sign of
Candidate

Orals

Sign of
Examiner

Grade
Amount

Referance No
CARGO
NAV1 NAV2 NAV3 NAV4
SOF1 SOF2 NAV
/ ASM
& Date

CARGO/
ASM

SOF

SB/MMD(KO)/2011/22222935

MMD
OCT-2011
KOLKATA

CHIEF
MATE

17196
21/09/2011

MMD
OCT-2014
KOLKATA

CHIEF
MATE

10687
17/09/2014

MMD
DEC-2014
KOLKATA

CHIEF
MATE

15400
21/11/2014

MMD
APR-2015
KOLKATA

CHIEF
MATE

4500

Fees Not Paid

MMD
APR-2015
KOLKATA

CHIEF
MATE

4500

BUPG37198609
83 26/03/2015

MMD
MAY-2015
KOLKATA

CHIEF
MATE

3000

CSBI373980275
6 10/04/2015

MMD
JUL-2015
KOLKATA

CHIEF
MATE

3000

DUPG38392483
32 07/06/2015

MMD
AUG-2015
KOLKATA

CHIEF
MATE

3000

DUPG39102775
55 17/07/2015

MMD
OCT-2015
KOLKATA

CHIEF
MATE

4500

DUPG40133976
66 11/09/2015

MMD
NOV-2015
KOLKATA

CHIEF
MATE

3000

EUPG40640710
13 14/10/2015

MMD
DEC-2015
KOLKATA

CHIEF
MATE

3000

EUPG41249477
46 20/11/2015

MMD
JAN-2016
KOLKATA

CHIEF
MATE

1500

EUPG41794532
75 18/12/2015

K 1. Sight Test :Date of Examination : _________________Result _____________Signature of Examiner

K 2. RESULT OF EXAMINATION :( for official purpose only) :

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No.
of
Atte Month
mpts

Name of Examiner
Written Papers

O : Oral , W :Written

OCT-2011

CHIEF
MATE

OCT-2014

CHIEF
MATE

FAIL
(PHS1)

FAIL (PHS1)

PASS
(PHS1)

FAIL
(PHS1)

FAIL
(PHS1)

ABSENT
(PHS1)

ABSENT
(PHS2)

PASS
(PHS2)

FAIL
(PHS1)

APR-2015

CHIEF
MATE

APR-2015

CHIEF
MATE

ABSENT
(PHS1)

CHIEF
MATE

ABSENT
(PHS2)

CHIEF
MATE

ABSENT
(PHS1)

AUG-2015

CHIEF
MATE

ABSENT
(PHS2)

OCT-2015

CHIEF
MATE

FAIL
(PHS1)

NOV-2015

CHIEF
MATE

SOF1 SOF2

NAV2

CHIEF
MATE

CARGO/
ASM

NAV1

DEC-2014

MAY-2015

Signal

Grade

Orals

NAV3

NAV4

NAV

CARGO/
ASM

SOF

PASS (PHS1)

ABSENT(
PHS2)

SB/MMD(KO)/2011/22222935
JUL-2015

PASS
(PHS1)

ABSENT(
PHS2)

ABSENT
(PHS2)

O-Capt. R. Sagar
9

10

11

DEC-2015

CHIEF
MATE

12

JAN-2016

CHIEF
MATE

FAIL (PHS1)

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 .

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L. REPORT OF EXAMINATION CENTRE

1. I hereby certify that Praveen Shankar has satisfactory produced testimonials and proof of sea-going
service/watch keeping service/approved workshop training as required for the grade.
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 First Mate of a Foreign Going Ship
3.

The candidate has passed his examinations for the functions as under :

Phase
PHASE1

Function

Level

Written
OCT-2011

SHIP OP.

Written Examiner

Oral

Oral Examiner

Assessment officer

MMD KOLKATA

M. FOR THE CHIEF EXAMINER OF MASTERS AND MASTES

1. I hereby certify that Praveen Shankar born at Jahanabad(Bihar) on 21.08.1983 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 First Mate of a Foreign Going Ship

SB/MMD(KO)/2011/22222935

3. The candidate has passed the examination of the functions as under :

Phase

Level

Function
Written

PHASE1

Sign. of Examiner with Remarks

Oral

OCT-2011

SHIP OP.

MMD KOLKATA

The candidate meets the requirements be eligible to be issued the Certificate of Competency as ...............................................
provisional certificate issued No.................................................................... on....................................................................

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

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as recommended by Mercantile Marine Department may be issued.

Page 6 of 7

Assessor at Directorate General of Shipping for Masters and Mates.

Remarks_____________________________________________________________________
Chief Examiner
(Masters and

SB/MMD(KO)/2011/22222935

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