Seafarer Application Form - DEV MARINE AGENCIES (PVT) LTD

* - Mandatory fields.

READ INSTRUCTIONS BEFORE FILL FIELDS. Please use (dd/mm/yyyy) format for any date inputs.

Do not take too much time to complete form and we recommend you to collect your data before start filling.

Please send email to "manning4@devmarineagencies.com" for any help/inquiries regarding seafarer applications submission.

Upload your picture *

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Min size - Width-200px, Height-200px (Passport Size) , Size should not more than 200Kb.
Supported Formats - jpeg, png, jpg, svg
Use slider controller at bottom of first box for zoom in/out the image before crop.

THIS IS THE FINALIZED PROFILE PICTURE

Personal Details

Family Name *

Rank *(First, select department and then select your rank. )

Middle Name/Other Names *

Email Address*

NIC *

Nationality *

Place of Birth *

D.O.B * (dd/mm/yyyy)

Passport *

Issued place *

Issued date *

Expiry date *

CDC No *

Issued place *

Issued date *

Expiry date *

SID No

Issued place

Issued date

Expiry date

Height (cm) (Insert numbers only)*

Weight (Kg) (Insert numbers only)*

Actual BMI

Limit

Marital Status *

No. of children (Insert numbers only)

Address & Contact Details

Address / Nearest Airport (Click to fill or skip)

Home Address (including City/State/Province/Country) (Insert comma mark for separate each City/State/Province/Country)

Nearest Airport

Telephone No. (Landline, include Country & City Code) *

Telephone No. ( Mobile/Cell include Country Code)*

Family / Next of Kin Details

Click to fill or skip

Full Name (Family, Middle, Other)	NIC/PP	Relationship	Date of Birth	Telephone/Contact No. (With Country Code)



Address

Education / Academic Qualifications

Click to fill or skip

Name of College / University attended	Location	From	To	Qualification Received

National License/Certificate of Competency/Endorsement details *

Grade	Number	Date of Issue	Date of Expiry	Issuing Country

GMDSS / Marine High Voltage

Click to fill or skip

Grade	Number	Date of Issue	Date of Expiry	Issuing Country

Flag State Licence/ Certificate of Competency/ Endorsement Details

Click to fill or skip

Grade	Number	Date of Issue	Date of Expiry	Issuing country

Details of Traning / Upgrading Courses & Certificates

Click to fill or skip

Course Name	Cert. Number	Date of Issue	Date of Expiry	Place of Issue

Visa Details

Type	Issued	Expires	Place of Issue
USA Visa
Australian Maritime Crew Visa (MCV)

Date of Availability to join a Vessel

Sea Service Record

IMPORTANT - Please state most recent sea service first.

Please be attention when fill this table and need SCROLL RIGHT FROM VERY BOTTOM SCROLL BAR due to many columns and make sure to insert correct data also recheck before submit form.

Vessel Name	Flag	Owner Manager	Rank (Select one rank from DECK , ENGINE or SMALL CRAFT/COASTAL)	Type	DWT	Engine Make	Engine Model	BHP/KW	UMS (Y/N)	Required field From (dd/mm/yyyy)	Required field To (dd/mm/yyyy)	Sea Time(Months)	Days	Required field Reason for Disembarkation

Required for engine room staff only.

For the bulk carrier type, Please state , MBLK for Mini, HBLK for Handy , LOGB for long carrier, HMBC for handymax, SMBC for supermax, PBLK for panamax, KSMX for kamsamax , CBLK for capesize, VOLC for very large ore carrier & WOOD for Wood chip carrier.

For Tankers , please state , LPGP for pressurised , LPGS for semi-refrigerated, LPGR for fully-refrigerated ,LPGE for Ethylene, LPCH for LPG/Chemical, CHET for chemical, PROT for product Tanker, MRP for Medium range product, LRP for long range product , AOIL for Afraamax, SOIL for Suezmax , VLCC for very large crude carrier, & ULCC for Ultra large crude carrier.

Any Remarks

How you got information regarding DEV Marine Agencies PVT Ltd ?

Please make sure to recheck added data above in whole form before submit.