Seafarer Bio-Data & Application Form (RPS 01-A)

Section 1: Position & Personal Details

Specify your applied maritime rank, target availability, and personal identification details.

Step 1 of 7

1. Rank & Availability

Position Applied For *

Willing to accept a lower rank? *

YES NO

Date of Availability *

2. General Identification

Full Name (As per CDC / Passport) *

Date of Birth *

Place of Birth *

Nationality *

Marital Status *

Nearest International Airport *

Email Address *

Primary Mobile / WhatsApp Number *

Permanent Address *

Present / Correspondence Address

3. Physical & Safety Gear Measurements

Height (cm) *

Weight (kg) *

Boiler Suit Size *

Safety Shoe Size *

Section 2: Next of Kin, Family & Medical History

Emergency contact details, family dependents, and MLC 2006 statutory medical fitness declarations.

Step 2 of 7

1. Next of Kin (Emergency Contact)

Full Name of Next of Kin *

Relationship *

Contact Telephone Number *

Address of Next of Kin *

Post Code • Alternative Phone No.

2. Family Dependents Data

Provide details for spouse and dependent children for medical insurance and visa facilitation records.

Family Data	Name	Date of Anniv	D.O.B	PPT. No.	D.O.I	P.O.I	D.O.E	ECNR	Action

3. Statutory Medical History

(a) Have you ever signed off from a ship due to Medical reasons?

Yes No

(b) Did you suffer or are you presently suffering from any disease likely to render you unfit for service at sea or likely to endanger the health of others on board?

Yes No

(c) Are you addicted to alcohol or drugs of any kind?

Yes No

(d) Have you suffered from any of the following conditions?

(e) Did you ever undergo psychiatric treatment?

Yes No

Additional Medical Details

Explanation for medical unfit disease

Explanation for medical addiction

Explanation for medical psychiatric

Explanation for med malaria

Explanation for med diabetes

Explanation for med epilepsy

Explanation for med nervous

Explanation for med hepatitis

Section 3: Travel Documents, Visas & Academics

Passport validity, flag visas, union membership, and institutional pre-sea training qualifications.

Step 3 of 7

1. Travel Documents & Passport

Passport Number *

Date of Issue *

Place of Issue *

Date of Expiry *

ECNR Status *

Blank Pages Remaining *

2. Visas & Union Membership

U.S. VISA Status

U.S. Visa Date of Issue

U.S. Visa Date of Expiry

MUI (Maritime Union of India) No.

MUI Date of Expiry

Any Other VISA (e.g. Schengen, UK, Singapore)

3. Educational Background

School / College / University	From Date	To Date	Highest Qualification Attained	Action

4. Pre-Sea Training & Cadetship

Pre-Sea Training Institute / College

Period (From - To)

Grade / Marks • Degree

DNS / HND / TME Training Institute

Period (From - To)

Grade / Marks • Degree

Additional Travel and Training Records

U.S. visa place of issue

U.S. visa number

DNS / HND / TME 2 institute

DNS / HND / TME 2 from

DNS / HND / TME 2 to

DNS / HND / TME 2 grade / marks

DNS / HND / TME 2 degree

DNS / HND / TME 3 institute

DNS / HND / TME 3 from

DNS / HND / TME 3 to

DNS / HND / TME 3 grade / marks

DNS / HND / TME 3 degree

Additional Visas

Include the visa type and number in the name. Maximum 10 records.

visa name	visa issue date	visa poi	visa expiry date	Remove

Section 4: CDC Details, Licenses & STCW Courses

Seaman's Books (Continuous Discharge Certificates), Certificate of Competencies, and mandatory STCW modules.

Step 4 of 7

1. INDOS Details

INDOS Number *

Issuing Authority

2. Continuous Discharge Certificates (CDC / Seaman's Book)

Flag State Seaman's Book	Number	Date of Issue	Date of Expiry	Place of Issue
Indian CDC *
Panama CDC
Liberian CDC
Honduras CDC
Cook Islands CDC
Bahamas CDC
Belize CDC
Vanuatu CDC
Palau CDC
Other Flag CDC

3. Certificate of Competency (CoC / Licenses)

License / CoC	Rank / Grade	Number	Date of Issue	Date of Expiry	Place of Issue
Indian CoC
Honduras License
UK CoC
Panama CoC
Cook Islands License
Other Flag License

4. Tanker Familiarization & DCE Endorsements

Course / Endorsement	Level / Grade	Certificate Number	Date of Issue	Date of Expiry	Issued By
OTFC (Oil Tanker Familiarization)	Basic / Level I
CTFC (Chemical Tanker Familiarization)	Basic / Level I
LGTC (Liquid Gas Tanker Familiarization)	Basic / Level I
TASCO (Advanced Oil Tanker Training)	Advanced / Level II
CHEMCO (Advanced Chemical Tanker Training)	Advanced / Level II
GASCO (Advanced Gas Tanker Training)	Advanced / Level II
DCE - Oil Endorsement
DCE - Chemical Endorsement
DCE - Liquefied Gas Endorsement

5. Key STCW & Offshore Safety Modules

Module Name	Certificate Number	Date of Issue	Date of Expiry	Issued By
PST (Personal Survival Techniques)
FPFF (Fire Prevention & Fire Fighting)
EFA (Elementary First Aid)
PSSR (Personal Safety & Social Resp.)
STSDSD (Security Training Designated Duties)
PSCRB (Survival Craft & Rescue Boats)
AFF (Advanced Fire Fighting)
MFA / Medical Care
ECDIS (Electronic Chart Display)
GMDSS / GOC
High Voltage (HV) Safety > 1000V
Yellow Fever Vaccination
Offshore: BOSIET / OPITO / H2S / HUET

Remaining Indian and Other Flag Courses and Certificates

Leave courses you have not completed blank. Existing certificate entries above are retained.

Course	Certificate Number	Issue Date	Expiry Date	Issued By
INDIAN: REF PSSR
INDIAN: REF PST
INDIAN: REF FPFF
INDIAN: REF EFA
INDIAN: REF STSDSD
INDIAN: PSSR AMEND
INDIAN: WATCHKEEPING
INDIAN: AB DECK
INDIAN: AB ENG
INDIAN: COOK
INDIAN: WELDER
INDIAN: FITTER
INDIAN: ETO
INDIAN: BOSIET
INDIAN: OPITO
INDIAN: H2S
INDIAN: HUET
INDIAN: OTHER
OTHER FLAG: BASIC
OTHER FLAG: STSDSD
OTHER FLAG: PSCRB
OTHER FLAG: FRB
OTHER FLAG: AFF
OTHER FLAG: MFA
OTHER FLAG: GMDSS
OTHER FLAG: SSO
OTHER FLAG: LRTM
OTHER FLAG: MEA
OTHER FLAG: ARPA
OTHER FLAG: RADAR
OTHER FLAG: ECDIS
OTHER FLAG: ISPS
OTHER FLAG: BRM
OTHER FLAG: BTM
OTHER FLAG: ERS
OTHER FLAG: ERM
OTHER FLAG: LCHS
OTHER FLAG: MEDCARE
OTHER FLAG: SAT
OTHER FLAG: HV
OTHER FLAG: NAV WATCH
OTHER FLAG: ENG WATCH
OTHER FLAG: AB DECK
OTHER FLAG: AB ENG

Additional Licences

Add further licences beyond the flag-specific entries above. Maximum 12 records.

Issuing Flag / Country	Rank	Licence Number	Issue Date	Expiry Date	Place / Authority	Remove

Additional Named Certificates and Courses

Include the course category and issuing flag in the name. Maximum 20 records.

certificate name	certificate no	certificate issue date	certificate expiry date	certificate by	Remove

Section 5: Previous Sea Service (Last 10 Years)

Starting from your most recent vessel sign-off. The system automatically computes contract durations (Months & Days).

Step 5 of 7

#	Owners / Manager	Vessel Name	Built	Type	GRT	DWT	Engine Make	BHP	Rank	From Date	To Date	Duration	Sign-Off Reason	Act
1
2
3

Section 6: Miscellaneous & Technical Experience

Specific cargo handling experience, crane/automation types, trade routes, CDI/PSC inspections, and drydocking.

Step 6 of 7

1. Deck Officers • Cargo & Pump Experience

Bulk Cargoes Carried

Product Tanker Cargoes

Chemical Cargoes Carried

Tanker Pump Types

2. Marine Engineers • Machinery & Automation

Automation Types • Engine Remote Control

Deck Cranes (Type • Make)

Cargo Grabs (Type • Capacity)

3. Electrical Officers (ETO) • Systems

Automation (Type)

NOR Control System

Crane Hydraulics / Electro-Hyd.

PLC Makes & Models

4. General Trading Areas & Inspections

General Trading Areas Experienced *

Dry Docking Experience (Vessels • Scope • Shipyards)

CDI Inspection Experienced?

Yes No

Port State Control (PSC) Inspections

Other Oil Major Inspections (SIRE / RightShip)

Additional Inspection and Dry Docking Records

Cdi details

Drydock vessel 1

Drydock nature 1

Drydock vessel 2

Drydock nature 2

Drydock vessel 3

Drydock nature 3

Section 7: Wages, Bank Details, CV & Declarations

Provide your wage expectations, payroll account, attach your curriculum vitae, and sign statutory declarations.

Step 7 of 7

1. Wage History & Expectations

Last Drawn Wages (USD or INR / Month) *

Expected Wages (USD or INR / Month) *

2. Savings Bank Account (Domestic Payroll)

Account Holder's Name *

Bank Name *

Account Number *

IFSC Code of the Bank *

Bank Branch Address

Anticipated Date of Joining

3. NRI / NRE Account (Optional)

Account Type

NRI Bank Name

NRI Account Number

IFSC / SWIFT Code

4. Curriculum Vitae & Document Upload

Attached Seafarer CV / Resume (PDF / DOC / DOCX) * Max 10MB Click or drag & drop your CV (PDF/DOCX) Authentic PDF, DOC, or DOCX formats verified via magic bytes on server

5. Seafarer Declaration & Legal Undertaking

True & Accurate Disclosure: I declare that all 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 License issued to me has ever been revoked or suspended. I also certify that my medical history contained above is true and if any false statement or undisclosed material information about past illness or injury will disqualify me from any employment benefits and claims. *

Social Media & Grievance Redressal: I hereby declare that I will not participate in any unauthorized group/individual communication in any social media sites or other public platforms detrimental to the company and I shall abide by the law. For any grievance I shall follow the official company complaint procedure. I understand that furnishing or spreading incorrect information about the company would make me liable to penal action. *

Confirmation of Zero Fees: Also, I confirm that I have not paid any donation / recruitment fees / service charge / any other charge for joining the vessel. *

Signed by Candidate (Type Full Name) *

Place of Submission *

Date of Signature *

FOR OFFICE USE ONLY / TECHNICAL INTERVIEW RECORD

This section is retained for Sea & Seas Technical Superintendents during candidate interview and matrix evaluation:

Technical Aspect: Pending Interview

Safety Aspect: Matrix Review

Pollution Prevention: MARPOL Compliance

Operation Aspect: Vetting Matrix

Additional Account Details

Bank post salary

Bank account type

NRI holder name

NRI bank address

Your typed name acknowledges this application. Company receiving and interview fields are completed by staff.

Seafarer Application & Bio-Data

Section 1: Position & Personal Details

Section 2: Next of Kin, Family & Medical History

Section 3: Travel Documents, Visas & Academics

Section 4: CDC Details, Licenses & STCW Courses

Section 5: Previous Sea Service (Last 10 Years)

Section 6: Miscellaneous & Technical Experience

Section 7: Wages, Bank Details, CV & Declarations