GOVERNMENT OF INDIA

MINISTRY OF PORTS, SHIPPING AND WATERWAYS

GOVENRMENT SHIPPING OFFICE
APPLICATION FOR CONTINUOUS DISCHARGE CERTIFICATE (CDC)
Application No. : SMO(M)/2024/313209 Application Date : 07-SEP-2024
Office Applied To : SHIPPING MASTER OFFICE MUMBAI
Personal Details
Name of the Candidate : BISWAL NIRAKAR
Father's name : BINOD BISWAL
Sex : Male Date of birth : 01-SEP-2006
Place of birth : LANGULIABEDA,ODISHA Nationality : Indian
INDOS No. : 24ZN8322 Indos Issue Date :
Height ( in cms ) : 167 Colour of eyes : BLACK
Colour of hair : BLACK
Identification Marks
Valid Passport No.
Passport Issue Date
SMO(M)/2024/313209
: MOLE ON THROAT
: AA060561
: 28-MAY-2024
Passport Issue Place
Passport Expiry Place
: BHUBANESWAR
: 27-MAY-2034
10th Standard Pass Certificate Details
Name of Board : BOARD OF SECONDARY EDUCATION,ODISHA
Year of Passing : 2022 Certificate No. : 222101818
Permanent Address Details
House No. : -- Street : LANGULIABEDA TULASIPAL
Village/Post Office : BANARPAL District : ANUGUL
State : Odisha Pin Code : 759128
Phone No. with STD Code : 9337371251 Nearest Police Station : BANARPAL
Email ID : [email protected] Mobile No. : 9337371251
Next-Of-Kin Details
Name of Next of Kin : BINOD BISWAL House No. : LANGULIABEDA
Relationship with Seafarer : FATHER Village/Post Office/Tehsil : BANARPAL
Street : TULASIPAL State : Odisha
District : ANUGUL Phone No. with STD Code : 9861783443
Pin Code : 759128
STCW Course Details
Sr. No. Name of course Certificate No. Date of issue Name of Institute
MARITIME EDUCATION TRAINING &
1 Basic Safety Training (STCW-BASIC) 3020066101240246 24-JUN-2024
RESEARCH INSTITUTE
Security Trng. for Seafarer with Designated Security Duties MARITIME EDUCATION TRAINING &
2 3020066621240476 26-JUN-2024
(STSDSD) RESEARCH INSTITUTE
Medical Certificate
Name of the Doctor : DR.S K SINHA
DGS Approval No. of the Doctor : MAH/MUM/40/2015 Place of issue of Medical Certificate : NAVI MUMBAI
Date of issue of Medical Certificate : 02-JUL-2024 Date of Expiry of Medical Certificate : 01-JUL-2025
Fees Details
Amount (Rs.) : 700 Payment Mode : ePayment
Payment Details : Fees :700.00 Paid on 07-09-2024 11:21:31 with payment reference no.YUR32431205259
Attached Document
Sr. No. Documents to be Uploaded
1 Scan copy of signed online application
2 Passport size (3.5 cm X 3.5 cm) photograph with clear white background face covering 70%
3 Scanned signature of seafarer
Coloured scanned copy of original Passport (Pages where personal detials, Photo,address details and signature of passport authority are
4
displayed )
5 Coloured scanned copy of original 10th Standard Pass Certificate / Marksheet
6 Coloured scanned copy of original Medical Fitness Certificate from DGS Approved Doctor ( Appendix IV and V )
Coloured scanned copy of original permanent address proof (Any one of them Passport,Aadhaar Card,Election Commission Photo ID card,and
7
Permanent Driving License)
Declaration
Declaration & Undertaking of Candidate ( BISWAL NIRAKAR )

Report generated on : 07/09/2024 11.22 AM Page 1 of 2

 I hereby declare that all the statements made in this application are true and complete to the best of my knowledge and belief and nothing has been
concealed/distorted.
I also affirm and declare that I have not previously been issued with a Continuous Discharge Certificate-cum-Seafarer’s Identity Document (CDC) and I
have not submitted an application for CDC to any other Shipping Master in India.
I am aware that, if at any time, I am found to have concealed/distorted any material information and the Shipping Master has reasons to believe that I
have obtained the CDC by presenting false or erroneous information, my CDC will be cancelled/suspended forthwith as per the provisions contained in Rule
9 of Merchant Shipping (Continuous Discharge Certificate) Rule, 2017 as amended.

I Agree.
Place : ................................... Signature of the Candidate : ..................................................
Date : 07-SEP-2024 Name of the Candidate :BISWAL NIRAKAR

SMO(M)/2024/313209

Report generated on : 07/09/2024 11.22 AM Page 2 of 2