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Horobets Dmytro
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22 views1 page

Course Entry Form

Uploaded by

Horobets Dmytro
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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d' Amico Ship Ishima India Pvt. Ltd.

OU
CCO NT
RSSEE EEN
UR OR
RYY FFO
TR RM
M
Please fill in all the relevant details in capital letters.

Course Name EMS & ECP Date: 28.09.2020 Batch No.

Full Name Horobets Dmytro

Rank Wiper

Date of Birth 11.11.1993

Academic Qualification Second class motorman

INDos Number 11079/2015/11

Certificate of Competency held 20.04.2015

Certificate of Competency No. 11079/2015/11

DCE endorsements Pet / Chem / Gas (please circle)


C. D. C No. Date of Issue Place of Issue
AB516461 16.05.2013 Ukraine
Passport No. Date of Issue Place of Issue
FH938721 19.09.2017 Ukraine

Home Address Vinnitsa, Ukraine

Tel. No. (Res) [specify the code if any]


Ukraine Tel No. [if any]
Mobile: +380969203792
Email [email protected]
Present Company Danica crewing services
Reference Person

_________________________ ________________________
Approved by Candidate Signature

DSIPL/TRNG-IN/7.5/02 15 JAN 2010 REV- 00


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