V.

SHIPS MANAGEMENT SYSTEM (VMS)

Application Form
[PLEASE USE CAPITAL OR UPPERCASE LETTERS TO COMPLETE THIS FORM] Individuals Code Number

1. Personal Data
First Name ZAHEER Middle Name (s) UDDIN Last Name / Surname BABAR

Nationality (or current Citizenship ) PAKISTANI Marital Status1: MARRIED

Country of Origin PAKISTAN

Date of Birth: 06 / _01 / 1980__

(DD / MM / YY)

Place / City of Birth SAHIWAL

Religion Gender : Male MALE ISLAM: Female 1 Select from : Single Married Divorced Common Law Partner Widowed Separated Rank applied for: 3RD ENGINEER Willing to accept lower rank? Yes No Available From (date): _09_ / 03 / _12_
(DD / MM / YY)

Primary / Permanent Address:

Alternative / Temporary Address:

Until: ____ / ____ / ___

City:KARACHI State: SINDH Nearest Airport :KARACHI Mobile Tel. Contact Method : Collar:14.5
cm

Post Code: Country : PAKISTAN Home Tel:03227041551 Fax: Email Chest: Fax
cm

City: State: Phone: Email: Mobile Phone Waist:

cm

Post Code: Country:

Home Phone Inside Leg:

cm

Post Cap: cm

Specify size as S, M, L, XL, XXL for :S

Sweater size:

SBoilersuit size:

Shoe Size:42

2.

Personal ID / Documents / Visa

Type of Document / ID 1 Seamans Book (National) Passport US Visa C1/D National Seaman ID Yellow fever Australia MCV PAKISTAN PAKISTAN 36502-1356153-1 54986 22/09/2010 10/04/04 SAHIWAL KARACHI 31/08/2020 14/04/14 Country of Issue PAKISTAN PAKISTAN No. 2918/EO AB3021532 Date of Issue (DD / MM / YY) 19/06/2003 29/09/2010 Issued at (Place) KARACHI SAHIWAL Valid Until (DD / MM / YY) 18/06/2013 28/09/2015

GIVE TAX INFORMATION BELOW ONLY IF REQUESTED TO DO SO

Social Security
Number: Issuing Country Number:

Personal Tax
Issuing Country:

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V.SHIPS MANAGEMENT SYSTEM (VMS)

3.Nominee / Next of Kin & Family Details
Full Name of Nominee for compensation in case of fatality: _AYESHA ZAHEER _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _________ Address: HOUSE NO 457/R FARID TOWN City:SAHIWAL Email:
1

Relationship1 WIFE_ _ _ _ _ ___

Gender : Male Female Nationality :PAKISTANI

54000 Tel:

Country:PAKISTAN Mobile:03226700949

Select From : Spouse Partner Child Parent Grand Parent Other Relative (Please Specify)

Family Data:
Relationship Spouse / Partner Child Child Child Child Child
2 2

First Name F F F F F

Last Name

Date of Birth

Passport No.

Issued

Place

Valid Until

M M M M M

Indicate type of valid visa3 Strike out inapplicable item

3

USA

Canada

Brazil

Schengen

UK

Other

Please consider period on board

4. STCW-1978 (amended 1995) Compliant Certificates / Courses and Other Qualifications: (Add separate sheet if data exceeds space available.) Description of Cert / Course (A) Reg I Personal Training Record Reg I/14 Medical Fitness Cert Reg I/9 (B) Reg VI / 1 Basic Safety Training PAKISTAN Personal Survival Techniques PAKISTAN Elementary First Aid Fire Fighting & Fire Prevention Personal Safety & Social Resp. PAKISTAN PAKISTAN PSTC0211 EFA0323 FPFF0199 PSSR-0243 07-02-03 12-02-03 21-02-03 28-02-03 LAHORE LAHORE LAHORE LAHORE IMS LHR IMS IMS LHR IMS LHR Country of Issue Number Date of Issue (DD-MMYY) Date of Expiry (DD-MMYY) Place of Issue Issuing Authority / Body

(C) Reg VI / 2 4 Additional Training Proficiency in Survival Craft & Rescue Boat PAKISTAN Fast Rescue Boats Advanced Fire Fighting Medical First Aid Medical Care (Master / C/O) PAKISTAN PAKISTAN

002189 0470 0337

04-05-05 05-05-05 13-04-05

KARACHI KARACHI KARACHI

PROMITY PROMITY PROMITY

(D)

Reg II / 1-4, III / 1-4 Officers Certificate of Competency & Ratings Watch-keeping Certificate (including flag state endorsements) C.O.C CLASS IV PAKISTAN 1119 30-06-05 03-02-15 KARACHI PANAMA ENDORSEMENT PANAMA 03-02-15 PANAMA

Enter here actual description given in the Competency Certificate / Watchkeeping Certificate held by you Other mandatory/recommended Certificates / Courses (as applicable) ARPA (Reg II/1 + Solas) Radar Simulator English Language Bridge Team / Resource Mgmnt Hazmat (US 49CFR)

(E)

Select as applicable: Passport Seamans Book Seaman Passport Seafarers Identity Document Registration Book National ID Card PAG-IBIG Housing Insurance Health Insurance Overseas Emp Cert PHL Card Pension Fund Provident Trust Professional Organisation Driving Licence Visa Vaccination Yellow Fever.

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V.SHIPS MANAGEMENT SYSTEM (VMS)

Shiphandling /ShipManoeuvring Simulator Shipboard Security Officer ECDIS

Description of Cert / Course

Country of Issue

Number

Date of Issue (DD-MMYY)

Date of Expiry (DD-MMYY)

Place of Issue

Issuing Authority / Body

(F)

GMDSS Certificates (including flag state endorsements) GMDSS (Main Issuing Authority) GMDSS (Flag State) GMDSS (Flag State) GMDSS (Flag State) GMDSS (Flag State) GMDSS (Flag State)

(G)

Reg V / 1 Special Requirement for Tankers Country Level1:Asst Description Number Level2:Incharge of Issue Endorsement Oil Endorsement Chem I/II Endorsement Chem III Endorsement Gas Tanker Familiarisation Tanker Familiarisation Tanker Familiarisation Special Tanker Safety Special Tanker Safety Special Tanker Safety (Oil) (Gas) (Oil) (Gas) Para 1 Para 1 Para 2 Para 2 (Chemical) Para 1 LEVEL 1 PAKISTAN 1391/M

Date of Issue (DD-MM-

Date of Expiry (DD-MM03-02-15

Place of Issue KARACHI

Issuing Authority / Body KARACHI

(Chemical) Para 2

(H) V/2 and V/3 Special requirement for Passenger / Ro-Ro Passenger Vessels Vsl Type Date of Country of Place of Number -Pax / Issue Issue Issue RoRoPax (DD-MMCrowd Management Description Crisis Mgmnt & Human Behaviour Pax Safety, Cargo Safety & Hull Integrity Pax Safety Familiarisation Training Safety Training RoPax

Issuing Authority / Body

5. Sea Experience : (Start the listing below with the most recent experience)
Company Flag & Vessel Name Type
(1)

GRT

DWT

Main Engine

(2)

BHP

Rank

Date Date To From dd/mm/yy dd/mm/yy

FESM FESM MSC MSC FLEET FLEET FLEET ENTICE TERRA MARINE

B.M HOPE/PANAMA B.M HOPE/PANAMA MSC LUCIA/FEDIRICA MSC DENNISE MV UNION SPIRIT M.V SERENE STAR M.V SERENE STAR MV ATLANTIC BREEZE M.T TINOS

B/C B/C CON CON B/C B/C B/C B/C TNC

16374 16374 14953 28176 17356 36561 36561 39802

29129 29129 20239 36000 25000 45000 45000 45600

SULZER 7RND 68 SULZER 7RND 68 SULZER 6RND 90 SULZER 10RND 90 SULZER 7RND 68 MITSUI MAN B&W MITSUI MAN B&W MITSUI MAN B&W MITSUBISHI 8UEC75LS2

13300 13300 20100 29000 11550 12120 12120 12345 23640

3RD ENG 3RD 3RD 3RD 3RD 3RD 4TH 4TH

24-01-11 25-07-11 26-02-10 28-01-09 02-09-08 26-11-07 25-05-07 12-08-06 01-10-05 24-08-10 04-06-09 27-01-09 29-03-08 24-0907 31-03-07 10-04-06

147537 221000

TR.EN 13-04-04 06-03-05 G

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V.SHIPS MANAGEMENT SYSTEM (VMS)

(1)

Use only the following abbreviations for vsl types:

B/C CO CH CH DR DP FS FS
(2)

Bulk Carrier Cellular Chem Carrier Chem Carrier Dredgers Dynamic Fishing Vsl FloatingStorage

FPS GC HLV LSH LIV LNG LOG LPG

FloatgProdStor General Cargo Heavy Lift Vsl Lash Live Stock LNG Carrier Log/Timber LPG Carrier

ML MS NV RIG OS OB O/ OT

Multi-purpose MultiServiceVes Naval Ship OffShore Oil Rig OffShore Supply Ore/Bulk/OilCarr Ore/OilCarrier Other

PA RF R/R PR SA SR SU TU

Passenger Reefer Ro/Ro RoRo-Pax Sailing Vsl Survey SelfTug

YAT TNB TNC TNP TNS TNV

Yacht Tanker(Bitume Tanker(Crude) Tanker(Produc Tanker(Storag Tanker(VLCC/ULC

Engineers to give make/model of engines, e.g. MAN 14V52/55A or SULZER 5RTA58

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V.SHIPS MANAGEMENT SYSTEM (VMS)

6. Medical History:
Sheet 4 All previous illnesses other than minor afflictions should be stated below or updated. If not previously disclosed, the Company is entitled to refuse any reimbursement of medical costs, claim for treatment or for any other insured benefits. (A) Have you ever signed off a ship due to medical reasons? Yes No NO If yes, please provide following details (If space is insufficient, attach additional sheets) :
Name of vessel Brief description of illness/injury/accident Date of occurrence Place of occurrence Blood Type:B++

(B) Have you undergone any operation in the past? If yes, please provide following details:
Details of operation Date

Yes

No
Present condition

Period of disability

(C) For what illnesses or accidents have you consulted a doctor during the last 12 months?
Details of illness / accident Date Therapy/Treatment

(D) Please give details of any health or disability problem

Details:

7.

Bank Details:

Other Details: (if any)

Bank Name Address Account Name Account No. Sort Code

8.

General

(A) Have you ever been denied a foreign visa? Yes No If yes, state which country and reason (if known) (B) Have you been the subject of a court of enquiry or involved in a maritime accident? If yes, please attach details (C) Give details below of two recent employers who we may contact for references:
Reference 1 Name of Company FESM Name of person to contact CAPTAIN RASHID CHARAG Address

Yes

No

Reference 2

Country Telephone 02134329042 I hereby declare that the above, including Medical History, is true. I further consent to the holding and processing by you and any of your direct or indirect parent or subsidiary or associated or affiliated companies (V Ships) and your or V Ships principals of personal data about me (including where appropriate data concerning racial or ethnic origin, religious beliefs, membership of a trade union, physical or mental health or condition, commission or alleged commission of an offence and the proceedings and the outcome of any proceedings relating thereto) for all purposes related to my application for employment on board vessels managed by V Ships or vessels owned or operated by third parties for whom V Ships is engaged to provide crew. I understand that this data will be stored in your databases in relation to my actual or potential employment by or through V Ships. Further, I confirm that the above may involve the transfer of my personal data within V Ships or to third parties worldwide.

Place: Date: .. Signature: ...

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V.SHIPS MANAGEMENT SYSTEM (VMS)

FOR OFFICE USE:

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Chapter 14 CRW13 Application Form File Ref: Office File: 11B Revision Number: 03