BIO DATA EX-POELR INDIAN NAVY

Personal Data (NAME should be strictly as per Passport )

Middle
First Name LOKANATH Surname DALAI
Name
Nationality INDIAN Place of Birth CUTTACK,ODISHA Date of Birth 15-Jun-78
Post Applied ELECTRICAL Yes Y
Accept to sail in lower rank? Available From: 17-Sep-13
For OFFICER No
Permanent address Local address
VILL-JANARDANPUR,PO-LENDURA, VILL-JANARDANPUR,PO-LENDURA,
AFFIX RECENT
VIA-KENDUPATNA VIA-KENDUPATNA PASSPORT SIZE
DIST-CUTTACK DIST-CUTTACK PHOTO HERE

Postal code: 754203 City CUTTACK Postal code: 754203 City CUTTACK
State ODISHA Country INDIA State ODISHA Country INDIA
Contact Details Code Tel.no. Contact Details Code Tel.no.
Mob no. 9337467547 Mob no. Mob no. Mob no.
Emaildalai4lokanath@gmail.com Nearest Airport BHUBANESWAR
Travel Documents
Passport No. Date of Issue Date of Expiry Place of Issue ECNR(Y/N/NA) Min. 4 blank pages(Y/N)
J8487559 21.11.2011 20.11.2021 BHUBANESWA Y
US Visa No.(C1D) Date of Issue Date of Expiry Place of Issue UID Number PAN Number
NA NA NA NA NA AHIPD2192F
CDC Details CDC No. Date of Issue Date of Expiry Issued by (Country) Place of issue
MUM217524 19.06.2013 18.06.2023 INDIA MUMBAI

License/Wkeeping License No. Date of Issue Date of Expiry Issued by (Country) Place of issue
NA
NA
NA
GMDSS License No. Date of Issue Date of Expiry Issued by (Country) Place of issue
NA
Endorsements
Vessel Type Flag Level (Y/N)
SUP OPS MGTNumber Date of issue Date of expiry Place of Issue
DCE(Oil) NA
DCE(Chemical) NA
DCE(Gas) NA

Family Name Date of Birth PPT. No. Date of Issue Date of Expiry Place of Issue
Wife BANITA DALAI 07.10.1983 NO
Child M
F F ANGELINA 31.01.2009 NO
Child M
F
Physical details
Height : 173 cms Weight : 82 Kgs Boiler Suit Size ( S , M , L , XL , XXL)XL Shoe Size (6, 7, 8, 9, 10, 11) :10
Eye Color: BLACK Hair Color: BLACK DISTINGUISH MARKA BLACK MOLE ON RT NECK
Civil Status: (Please mention "yes" where appropriate) Wedding Anniversary Date (if applicable):
Single N Married YES Separated N Divorced N Widowed N 04.07.2005
Next of Kin details
Middle
First Name BANITA Surname DALAI
Name
Sex: (M/F) F Relationship WIFE D.O.B 7.101983
Postal address:
VILL-JANARDANPUR,PO-LENDURA Postal code: 754203 City CUTTACK
VIA-KENDUPATNA State ODISHA Country INDIA
DIST-CUTTACK Contact Details Code Tel.no.
mebanitabehera83@gmail.com
Mob no. 9337467547 Email:
Academic Qualification(Highest qualification attained to be mentioned)
Name of the Institution Qualification From To Percentage/Grade
State Council of Technical Education & vocatDIPLOMA ELEC1994 2000 55.7
Country INDIA State ODISHA City BHUBANESWAR Postal code:
S.S.C (10th) Marks % : 61.47 H.S.C. (12th ) Marks % : NA H.S.C. (PCM) %NA
Pre-Sea course details
Name of the Institution Type of Degree From To
INDIAN NAVY 29.01.1997 31.01.2012
Country INDIA State City Postal code:
Details of Courses & Certificates Number Date of Issue Date of Expiry Issued by
Basic STCW Courses
Fire Prevention and Fire FPFF
Fighting
Basic Fire Fighting BFF
Advanced Fire Fighting AFF AFF/0247/018/13 11.05.2013 NAMAC(MB)
Elementary First Aid EFA
Medical First Aid MFA MFA,0246/018/13 16.05.2013 NAMAC(MB)
Medicare
Personal Survival Techniques PST PST/0260/025/13 24.04.2013 NAMAC(MB)
PSC
Proficiency in Survival Craft
RB PSCRB/0313/020/13
RB 24.05.2013 NAMAC(MB)
& Rescue Boat
Bridge Team Banagement BTM NO
Personal Survival & Social PSSR PSSR/0361/027/13 27.04.2013 NAMAC(MB)
Responsibility
Other STCW courses
Bridge resource Management BRM NO
Automatic Radar Plotting Aid ARPA NO
ECDIS NO
Ship Handling Simulator SMS NO
Engine Room SimulatorM ERS NO
O
Ship Safety Officer SOC NO
Ship Security Officer SSO NO
Vessel Type courses
Oil Tanker Familiarization OTFC NO
Vessel Type courses(Continued) Number Date of Issue Date of Expiry Issued by
Specialized training on Oil TAS
NO
Tanker Operations CO
Chemical Tanker CTFC NO
Familiarization
Specialized training on Chem CHEM NO
Tanker Operations CO
Gas Tanker Familiarization GTFC NO
Specialized training on Gas GAS NO
Tanker Operations CO
Liquid Cargo Handling M LCHS NO
Simulator O (O)
FRAMO NO
Other Courses
Pumpman training NO
Cookery course NO

Other Documents
Yellow Fever vaccination YF NO
INDOS Number 13ZL6845 03.05.2013 MMD(MB)
Vessel Type Experience(Please mark "Y" where applicable)
OFF SHORE OSV NO D P Vessel NA Anchor
Hndling v/l N
BULK Cape size NO Handy size NA Panamax N OBO N VLOC N
CHEM-OIL TANKER Type I NO Type II NA Type III N
CHEMICAL TANKER Chemical NO
Tanker
CONTAINER Container NO
GAS TANKER Fully-Ref NO LNG NA Pressurized N Semi-Ref N VLGC N
General
GENERAL CARGO NO PCC NA Reefer N Ro-Ro N
Cargo
OIL TANKER Product NO Crude NA LR Series N Suez Max N VLCC N
PASSENGER Cruise Line NO Ro-Ro NA STP N
OTHER Live Stock NO Heavy lift NA
Where did you get to know about Executive Ship Management Pvt. Ltd.(Please mark "Y" where applicable)
Contacted by ESM staff Print media Web sites Y Word of mouth
Testimonial Check
S/N Name of the company Person in charge Designation Phone No.
1
2
For Office use only
Medical History
N If yes,please give
(a) Have you ever signed off from a ship due to Medical reasons, (Please mark "Y" if applicable) details
Name of the vessel Date of incident Brief Decription(Injury/Illness/accident)

(b) Did you suffer or Are you Presently suffering from any Disease likely to render you unfit for Service at Sea or
 N
likely to endanger the health of others on board. (Please mark "Y" if applicable)
(c) Are you addicted to alcohol or drugs of any kind. N
(d) Have you suffered from following(Please mark "Y" if applicable)
Malaria N Diabetes N Epilepsy N Nervous Disability N Did you ever undergo psychiatric treatment : N
SEA SERVICE PARTICULAR SEA SERVICE DETAILS
S/N Name of Company Engine Total
Name of Vessel Rank Type GRT Make Model KW From To MM/DD
1 INDIAN NAVY INS GOMATI EMR I/II WARSHIP 3577 13.06.1998 26.05.2002 47/13
2 INDIAN NAVY INS BEAS LEMR WARSHIP 3272 02.02.2005 30.05.2008 39/28

I warrant and represent that:

1. The foregoing details are true and accurate and complete
2. There are no contractual or other restrictions (other than official visa/ work. Permit Approvals) or health conditions that may in any way Prevent or restrict me form being employed by you and fully perfor
3. I apply for employment with you by my own free will without any inducement or representative from you or your agents.
4. Further that no Certificate of competency or license issued to me has ever been revoked or suspended.
5. 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

Date________________ Rank__
EX POELR Signature of Seaman ___________________

For Office use only

INITIAL CHECK & VERIFICATION (Please mark "Y" if applicable)
A. Original licenses sighted by STCW and Training Certificates sighted by
Experience confirmed by interview by Other details confirmed by interview by
B. OC 09A-Offer letter Signed / attached Interview Sheet Signed / attached Trade test Certificate for new joiners Sighted
Assessment & Evaluation: Approved Conditionally approved Reject Re-interview by Sign/Name: Date:
C. 1 Data Entry done by Date: Zone: Sign:
2 Dox attached by: Date: Zone: Sign:
3 1&2 verified by: Date: Zone: Sign:
Total Reason for S/OFF
MM/DD
7/13 TRANSFER
9/28 TRANSFER

lly performing my work.

nefits and claims.

____

Date: