Eastern Pacific Shipping Pte Ltd.
EMPLOYMENT APPLICATION FORM
RECENT PASSPORT SIZE
COLOUR PHOTOGRAPH
STAFF CODE: RANK:
Office use only
VESSEL:
DATE AVAILABLE:
Office use only
SURNAME: PATIAL FIRST NAME: AKA OTHER NAME:
DATE OF BIRTH: 2/1/2001 PLACE OF BIRT BA NATIONALITY: INDIAN
PASSPORT NO. W0872580 ISSUED ON: 7/12/2022 EXPIRY DATE: 7/11/2032
S/BOOK NO. MUM542358 ISSUED ON: 2/23/2024 EXPIRY DATE: 2/22/2034
SID NO: (Seafarer's I M34595660 ISSUED ON: 3/15/2024 EXPIRY DATE: 3/14/2034
PERMANENT
VOP-NAIN, TEHSIL-BARSAR, DISTRICT- HAMIRPUR, HIMACHAL PRADESH- 176039
ADDRESS:
NEXT OF KIN: NAME:
Relationship
ADDRESS:
PHONES: FAX: E-MAIL:
NEAREST For officers - Please specify the nearest domestic
NEW DELHI airport. For all ratings - the nearest international airport.
AIRPORT:
MARITAL STATUS: SPOUSE NAME:
MARRIAGE DATE:
CHILDREN
SON / DAUGHTER NAME DATE OF BIRTH
PRE-SEA TRAINING / MARITIME SCHOOL / HIGHEST ACADEMIC QUALIFICATION (Specify School Name / Country, and Year attended)
Course Name Institude Name From Date - To Date
GENERAL PURPOSE RATING CHITKARA UNIVERSITY SCHOOL OF MARITIME STUDIES JUL 23 TO DEC 23
PAGE 1 OF 6 OFC06-11/24
Eastern Pacific Shipping Pte Ltd.
DOCUMENT STATUS
LICENSES GRADE REGULATION NUMBER ISSUE EXPIRY PLACE Authenticated
NATIONAL LICENSE (LIC) (Please refer to Note below)
NATIONAL DANGEROUS CARGO ENDORSEMENT (DCE) - OIL
NATIONAL DANGEROUS CARGO ENDORSEMENT (DCE) - CHEM
NATIONAL DANGEROUS CARGO ENDORSEMENT (DCE) - GAS
REVALIDATION OF NATIONAL LICENSE (REV)
S T C W COURSES Mark / Delete GRADE REGULATION NUMBER ISSUE EXPIRY PLACE Authenticated
SURVIVAL AT SEA / PERSONAL SURV. TECH. (SAS / PSST) 10602561012300616 12/2/2023 NA RAJPURA CUSMS RAJPURA
FIRE PREV. AND FIGHTING 10602561012300616 12/2/2023 NA RAJPURA CUSMS RAJPURA
ELEMENTARY FIRST AID / MEDICAL FIRST AID / MEDICAL CARE 10602561012300616 12/2/2023 NA RAJPURA CUSMS RAJPURA
PERSONAL SAFETY AND SOCIAL RESPONSIBILITIES (PSSR) 10602561012300616 12/2/2023 NA RAJPURA CUSMS RAJPURA
TANKER FAMILIARIZATION COURSE - OIL
TANKER FAMILIARIZATION COURSE - CHEM
TANKER FAMILIARIZATION COURSE - LPG
BASIC IGF COURSE
ADVANCED TANKER COURSE - OIL
ADVANCED TANKER COURSE - CHEM
ADVANCED TANKER COURSE - LPG
ADVANCED IGF COURSE
PROFICIENCY IN SURVIVAL CRAFT AND RESCUE BOAT (PSCRB)
ADVANCED FIRE FIGHTING
MEDICAL FIRST AID AND MEDICAL CARE
GMDSS
BRIDGE TEAM AND RESOURCE MANAGEMENT (BTRM)
ENGINE TEAM RESOURCE MANAGEMENT (ETRM) / ERM
ELECTRONIC CHART DISPLAY AND INFORMATION SYSTEM (ECDIS)
as per IMO 1.27
RISK MANAGEMENT AND INCIDENT INVESTIGATION COURSE (RMI)
SAFETY OFFICER COURSE (SOT)
SHIP SECURITY OFFICER (SSO)
SDSD-Designated Security Duties = YES 10602566212300615 12/2/2023 NA RAJPURA CUSMS RAJPURA
HIGH VOLTAGE TRAINING COURSE (C/E, 1/AE, 2/AE, 3/AE, E/E)
ENVIRONMENTAL OFFICER TRAINING COURSE
RADAR OBSERVER (ROC)
ARPA / RADAR SIMULATOR
OTHER COURSES GRADE REGULATION NUMBER ISSUE EXPIRY PLACE
SHIP HANDLING SIMULATOR (SHS)
LIQUID CARGO HANDLING SIMULATOR (LCH)
ENGINE SIMULATOR COURSE
U.S. VISA C1/D STATUS
YELLOW FEVER
COVID VACCINE
ELECTRONIC MAIN ENGINE COURSE
ME-GI ELECTRONIC ENGINE EXPERIENCE
MELGIP COURSE (Electronic Main Engine)
NABCO (AUTOCHIEF)
KONSBERG (IAS)
HIMSEN GENERATOR COURSE
REEFER CONTAINER & MAINTENANCE COURSE
HYDRAULIC COURSE
LNG BUNKERING COURSE
GTT - LNG CARGO HANDLING COURSE
FUEL GAS SUPPLY SYSTEM COURSE
Note: For Deck Officer, the COC should be valid for Navigational Watch on ships 500 gross tonnage or more.
PAGE 2 OF 6 OFC06-11/24
Eastern Pacific Shipping Pte. Ltd.
DETAILS OF PREVIOUS SEA SERVICE
LAST VESSEL ON TOP
PERIOD OF SERVICE
Vessel Details
(For Engine Staff : Vessel Type / Engine
YEAR details : Example : Container Carrier / B&W DWT TEU NAME OF OWNERS / MANAGERS
NAME OF VESSEL
BUILT
FLAG
- 12K98MC-C) H.P.* (CONTAINER ONLY)
RANK
AND THEIR CONTACT DETAILS Period in Month
FROM TO
(For Deck Officers : Vessel Type / ECDIS. (DD/MM/YYYY) (DD/MM/YYYY)
Example: Container, JRC 201C)
7.0
M. V. LENA 2009 MALAYSIA BULK CARRIER 1985 TR. DECK RATIN 11/17/2024 6/16/2025 APOLLO SHIPPING ANF TRADING SDN BHD.
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1. APPLICANTS TO ENSURE THAT COMPLETE SEA SERVICE FROM THE BEGINNING OF SEA CARRIER IS GIVEN. IF THIS PAGE IS INSUFFICIENT, PLEASE MAKE A PHOTOCOPY OF THIS PAGE AND WRITE
THE SEA SERVICE.
2. ENGINE DEPARTMENT APPLICANTS ESPECIALLY ENGINEERS TO ENSURE THAT HORSE POWER & DEAD WEIGHT IS WRITTEN UNDER COLUMN (TYPE OF VESSEL/MAN ENGINE DETAILS).
3. MANNING OFFICE TO VERIFY AND ENSURE THE ABOVE SEA-SERVICE IS TALLYING AGAINST CANDIDATE'S NATIONAL SEAMAN BOOK.
4. CANDIDATES APPLYING FOR LPG FLEET PLEASE SPECIFY WHICH SHIPS WERE FULLY PRESURIZED, SEMI-REFRIGERATED AND FULLY REFRIGERATED UNDER COLUMN (TYPE OF VESSEL/MAN ENGIN
5. PLEASE DO NOT CHANGE THE PAGE LAYOUT AND MARGINS.
Example : BSN, A/B x 3, O/S x 2, PMN 7
Manning Info of last vessel : Please specify ranks and number onboard Count
Deck Officers : MST, C/O, 2/O, 3/O
Deck Ratings : BSN, A/B, O/S, PMN O/S
Engineers : C/E, 1A/E, 2A/E, 3A/E,E/E,G/E) Was last vessel running in UMS ?
Engine Ratings : OLR, WPR, FTR) Yes
Catering : (Cook, STW, MSB/CBY)
Cadets : (DCT, ECD. ELC)
Total 0
PAGE 3 OF 6 OFC06-11/24
Eastern Pacific Shipping Pte Ltd.
SUMMARY OF OFFICER'S EXPERIENCE In years and months
Chemical LPG / VLGC / VLAC / LNG /
EXPERIENCE AS Crude Oil Tanker Product Tanker Bulk Container XXXX Car Carrier TOTAL
Tanker Tanker Ethane Carrier
MASTER C/E
C/O 1/AE
2/O 2/AE
3/O 3/AE
G/E E/E
TOTAL
ENGINE APPLICANT DECK APPLICANT
TYPE OF AUXILIARIES Please mention MODEL & TYPE TYPE OF ECDIS Please mention MODEL & TYPE
GENERATORS JRC
BOILERS FURUNO
PURIFIERS TRANSAS
COMPRESSOR TOKYO KEIKI
ELECTRONIC MAIN ENGINE EXPERIENCE PAPERLESS NAVIGATION EXPERIENCE:
ME-GI ELECTRONIC ENGINE EXPERIENCE
EXPERIENCE WITH MULTINATIONAL CREW: YES / NO NATIONALITY: YEARS / MONTHS:
REASON FOR LEAVING LAST COMPANY: YES / NO IS APPLICANT 18 YEARS OR ABOVE? YES / NO
AGREEABLE TO ACCEPT ONE RANK LOWER : YES / NO AGREEABLE TO JOIN VSL PLYING IN WAR ZONE HIGH RISK AREA: YES / NO
Blood Type: A+ Height 175CM Safety Shoes 42
Eye Sight with Glasses: 6/6 Weight 75 KG Boiler Suits XXL
Eye Sight without Glasses: 6/6 BMI Parka
APPLICANT'S DECLARATION: (Answers to questions A, B, C & D has to be either 'Yes' or 'No')
A. HAVE YOU BEEN THE SUBJECT OF A COURT OF ENQUIRY OR INVOLVED IN A MARITIME YES
ACCIDENT? _________
B. I CONFIRM THAT I AM WILLING TO WORK ONBOARD EPS VESSELS WITH ZERO ALCO YES
MEDICAL HISTORY:
ALL PREVIOUS ILLNESSES OTHER THAN MINOR ILLNESSES SHOULD BE STATED BELOW OR UPDATED. IF NOT PREVIOUSLY DISCLOSED, THE COMPANY IS ENTITLED TO
REFUSE ANY REIMBURSEMENT OF MEIDCAL COSTS, CLAIM FOR TREATMENT OR FOR ANY OTHER INSURED BENEFITS.
C. HAVE YOU EVER SIGNED OFF A SHIP DUE TO MEDICAL REASONS?NO
IF YES, PLEASE PROVIDE FOLLOWING DETAILS (IF SPACE IS INSUFFICIENT, ATTACH ADDITIONAL SHEETS) :
NAME OF VESSEL DATE OF OCCURRENCE PLACE OF OCCURRENCE
BRIEF DESCRIPTION OF ILLNESS / INJURY / ACCIDENT
D. HAVE YOU UNDERGONE ANY OPERATION IN THE PAST? ______ IF YES, PLEASE PROVIDE FOLLOWING DETAILS :
DETAILS OF OPERATION DATE PERIOD OF DISABILITY PRESENT CONDITION
E. FOR WHAT ILLNESSES OR ACCIDENTS HAVE YOU CONSULTED A DOCTOR DURING THE LAST 12 MONTHS?
DETAILS OF ILLNESS / ACCIDENT DATE THERAPY / TREATMENT
F. PLEASE GIVE DETAILS OF ANY HEALTH, ALLERGY OR DISABILITY PROBLEM
DETAILS:
I hereby confirm that all my certificates [Certificate of Competency, STCW certificates and other qualifications] are genuine and authentic. I confirm that I am NOT holding any fake certificates.
I declare that all information provided herein is to the best of my knowledge is true and correct. I am fully aware that witholding or providing wrong information will lead to termination of
employment and commencement of criminal proceedings.
I have read and understood the Recruitment Privacy Notice.
Akash
Patial 7/29/2025
Signature Date of application
I have confirmed the applicant is holding the certificates require as per QSP0912 / QSP0913 / QSP0918 applicable for his position.
EPS Representative / Agent Date
Eastern Pacific Shipping Pte Ltd.
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Eastern Pacific Shipping Pte Ltd.
CARGO INFORMATION SHEET
NOTE: Tick appropriate box for cargoes carried, and comment in the space provided.
Fleet A – GAS TANKERS Fleet A – PRODUCT / CRUDE TANKERS
Acetaldehyde JET A1
Anhydrous Ammonia NAPTHA
Butadiene PREMIUM UNLEADED PETROL (UNDYED)
Butane PREMIUM UNLEADED PETROL (DYED)
Butane / Propane Mixture UNLEADED PETROL / MOGAS
Butene LEADED PETROL / MOGAS
Butylenes AUTOMOTIVE GAS OIL
Diethyl Ether VGO
Dimethylamine CAT CRACKED GASOLINE
Ethyl Chloride CRACKER FEED
ETHANE LIGHT CYCLE OIL
Ethylene Oxide / Propylene Oxide Mixtures REFORMATE
Isoprene FUEL OIL 380 CST
Isopropylamine FUEL OIL BLEND COMPONENT
Methyl Acetylene – Propadiene Mixture HIGH SULPHUR FUEL OIL
Methyl Chloride LOW SULFUR WAXY RESIDUE
Monoethylamine CUTBACK BITUMEN
Propane BITUMEN FEEDSTOCK
Propylene CRUDE OIL
Vinyl Chloride Monomer CONDENSATE
Vinyl Ethyl Ether HIGH POUR POINT CRUDE
Vinylidene Chloride CLOUD POUR POINT CRUDE
Crude C4 CRUDE WITH HIGH VAPOUR PRESSURE
Methane HEATED CARGO
Fully Pressurized Ships Lightering Experience - Please list in detail
Semi Pressurized / Refrigerated Ships Parcel Trade Experience
Fully Refrigerated Ships
Special Cleaning After Prop OX (Give Details)
Special Cleaning After Butadiene (Give Details)
LPG
Experience of changeover of grade (Please give details about
Fleet B – BULK CARRIERS Fleet C - (CONTAINER AND CAR CARRIER)
Alumia DG Cargo
Sugar Reefer Containers Monitoring
Lime / Cement Mediterranean Mooring
Understanding of the Regulation regarding Verification
Petcoke
of the Gross Mass (VGM) of a packed Container
Grain Awareness of Synchronous & Parametric Rolling
Salt
Steel Products
Bagged Cargo
Coals
Ore
Iron
Sand & gravel
Copper
Limestone
Silica Sands
Pig Iron
Timber (UnderDeck)
Machinery (Boxed)
Transshipper Experience - Please list in detail
Remarks (if any)
Experience on geared bulk carrier / bulk carrier with cranes YES
PAGE 5 OF 6 OFC06-11/24
Eastern Pacific Shipping Pte Ltd.
OTHER INFORMATION / AREAS OF KNOWLEDGE
Oil Company Inspections / CDI (Please List)
Trade Areas (Please list in details last 2-3 vessels' trading areas)
Closed Loading / VECS.
Cargo Heating – Oil / Steam / Deck htr (Please List)
Tank Coating Type – Zn / SS / EPOXY (Please List)
Cargo Cooling Systems
Compressor Types
Inert Gas System (IGS)
Inert Gas Generator (IGG)
Gas Freeing
Specialist Gas Training
LNG / LPG bunkering operation
Bunker Management Procedure (Experience of changeover of bunker
for SECA & ECA (Please give details on which vessel)
Dry Dock Experience (Indicate shipyard and vessel name) M. V. LENA
New Delivery Experience from Shipyard (Indicate shipyard, vessel name)
Trading Area (Indicate areas)
Ice Navigation Experience (Indicate areas)
Scrubber experience (List vessel name where Scrubber was operational)
Type of Ballast Water Treatment Plant
SCR - Selective Catalytic Reduction
Dual Fuel Engine Experience (Indicate Maker, Type of Engine, Engine power)
GTT Membrane
Competencies for Fitters, Pumpman & Engine Ratings
Brazing skills (especially on refrigeration lines) Ability to perform Gas Welding
Welding skills – including gouging, grinding Ability to perform Grinding / drilling
Pipe fabrication including T-joints and Flange joints TIG Welding proficiency
Ability to carry inter-tank repairs & stainless steel repairs Ability to Repair & overhaul Machineries
Operational knowledge of engine overhaul & pump overhaul Other Skills - please mention in details
Gas cutting experience Plumbing Skills
Carpentery Skills
Reference Check
Name Company Designation/ Rank Mobile No.
ANKUSH CHANDEL EASTERN PACIFIC SHIPPING 2nd ENGINEER 7807243693 or 9459943693
PAGE 6 OF 6 OFC06-11/24
