CMA-CGM Crew-001A Application Form
CMA-CGM Crew-001A Application Form
Njordships Management India Pvt Ltd,Unit 101,Akshaya Shanta Door No: 27/44
Passport
Date of
Number Place of issue issue Date of expiry Issuing Authority
Visas
Type Number Place of issue Date of issue Date of expiry
C1/D (USA) 2024120477000 Chennai 03/05/2024 28/04/2029
1
C1 (USA)
D (USA)
Australia Entry visa
MCV (Australia)
Schengen
Education Background
School / College From To Highest qualification attained
college 2005 2008 DME
E-mail: imman.harish.90@gmail.com
Home tel number: 9894349264
1/7
Domestic Airport Tuticorin International Airport Chennai
Dependents
Name Date of birth Age Gender Relationship
Medical History
Have you ever signed off from
a ship due to medical reasons? No If yes give details
Name of vessel Date of Occurrence
2/7
Uniform Shirt size:L Uniform Trousers size: 34
Type of Marine Course IMO model Reference- Regulation Number Date of issue Date of expiry
course
1.19 - 1.20 1.13 - STCW Reg.
Basic Training 1.21 A-VI/1-1 to A-VI/1-4
Radar Simulator
STCW Reg II/1 par.2.5
ECDIS 1.27
US 49 CFR 172.700-
HAZ MAT 172.204
STCW
Ship simulator bridge teamwork 1.22 Reg II/1
BTM / ETM
STCW Reg VI/5 / ISPS
Ship Security Officer (SSO) Code
BASSnet
STCW Reg II/1 & II/2
Ship handling & manoeuvring
STCW Reg VIII/2
Bridge resource management US33CFR 157.415
Indos Number
Upgradation Course
Reefer Training
Malta:
4/7
Employment history (at least the last 5 years)
Vessel * Company Manning Agent Trading area Vessel Flag DWT / Year Main Engine Position Sign on Sign off Total Reason
type TEU built date date mm/dd for
** leaving
Make Type KW
***
man & BW
Green Park Xt ship Management china to USA containemonrovia 34000 2024 Dalian marin 14880 WIPER 18/06/202431/12/2024 contract Finish
Kawasaki Heavy Industries
man & BW
Cape med Xt ship Management china to USA bulk carrmonrovia 185827 2006 16860 WIPER 23/06/202328/01/2024 contract Finish
Hyundai Heavy Industries
man & BW
MV UTE Xt ship Management china to USA containemonrovia 65965 2007 45760 WIPER 8/9/2022 11/4/2023 contract Finish
cap capricorn Xt ship Management china to USA containemonrovia 51931 2013 doosan Enginman & BW 22890 wiper 25-09-2021 3/7/2022 contract Finish
WOLRD TANKER SHIP
MV AGROS MANAGEMENT SINGAPORE CRUDEBAHAMAS 34995 1996 Dalian marin man & BW 10685 WIPER 30/01/202128/03/2021 contract Finish
TEAM SHIPPING
LIMA-1 MANAGENT DUBAI SUPPLYST KITTIS & 1768 1996 WARSILA DIWARTSILA 3980 WIPER 4/4/2016 24/11/2016 contract Finish
2/O - 3/E
3/O - 4/E
E/O
Total
2/E
3/E
4/E
E/O
Total
References
Do you have any objection if we will contact your last employers for
Yes/No NO
reference?
If YES please specify why:
If NO please specify below:
Please give the name and address of your current or immediate past employer
Name of company
Name of person to
contact
Address
Tel number
Tel number
Name of company
Name of person to
contact
Address
6/7
Tel number
Bank details
INDIAN
Bank
OVERSEA Sort code:
name:
S BANK
Branch UDANGU Swift name
IOBAINBB092
name DI IBAN number:
56A 2 BY
Address: 2, Sri Ram Bus Stand Road, Udangudi 628203
Account Building,
Account
name/ HARISH I ###
number:
Title
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 License issued to me has
ever been revoked or suspended. I also certify that my medical history contained abocve 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__03/04/2025___
___________ Signature_______________________
7/7