Quality Assurance into the 21st

Century and beyond

Personnel Form

TSM Form
No. 070

THOME
SHIP MANAGEMENT PTE LTD

Application
Nomination
Promotion
Amendments

Date

27 May 2016

Position

CHIEF MATE

A. Personal

Family Name

Given Name

Middle Name

THAPLIYAL

SANJAY

Birth Date
(dd MM yy)

Place of Birth

Nationality

24 NOV 194

RUDRAPRAYA
G

INDIAN

Sex
X M

National Reg. No.

Religion
HINDU

Address

Contact No.

Email

FH 15/203 GTM FOREST & HILL OPP IIP GATE

HARIDWAR ROAD DEHRADUN
Passport No.

Place of Issue

Date of Issue

Expiry Date

Civil Status

L4493238

DEHRADUN

30/07/2013

29/07/2023

MARRIED

US Visa

Place of Issue

Date of Issue

Expiry Date

Nearest Airport

YES

NEW DELHI

24/07/2012

23/07/2017

DEHRADUN

Next of Kin

Family Name

Given Name

Middle Name

Relationship

THAPLIYAL

BHUWAN

CHAND

FATHER

Address

Tel/Cell/Fax

SAME AS ABOVE

+919412987866

B. National Certification

Graduated From

Highest Education

Year

SHOBHIT UNIVERSITY

B COM

2016

CONTROLLED

Revision: 01 Jan 2014

Approved by DPA/DMR
Page 1 of 8

TSM Form No. 070

Personnel Form

THOME
SHIP MANAGEMENT PTE LTD

Seamans Book No.

Issued Date

Expiry Date

Medical Clinic

Expiry Date

MUM124582

27/06/2015

26/06/2025

DR KANWAR

06/10/2016

National Certificate No.

Issued Date

Expiry Date

Issuing Country

IFO 19415

23/09/2015

29/07/2015

INDIA

C. Certificates and Qualifications

Documents Held

STCW95

Flag
State

Number

Issued
(DDMMYY)

Expiry
(DDMMYY)

Foreign Documents
REG III - Engine
REG IV Radio
Tanker Qualification

REG V/1-2 Assistant

Advanced Oil

REG V/1-2 In Charge

Advanced Chem
Advanced Gas
General Tanker Fam.
COW/Inert
Familiarisation
Training/SSO
Basic Safety/PST

104/3895/0636

BPMA/PST/793/2003

FOS
MA

21/12/201
3

BPM

17/09/201
3

NAT
COM

14/04/201
1

NAT
COM

07/04/201
1

ARI

13/09/201
4

Advanced Safety Course

ARPA
ROC
RSC

NATCOM/ARPA/059/2011

NATCOM/ROC/063/2011

RA14122

Bridge Team Management

CONTROLLED

Revision: 01 Jan 2014

Approved by DPA/DMR
Page 2 of 8

TSM Form No. 070

Personnel Form

THOME
SHIP MANAGEMENT PTE LTD

GMDSS/INMARSAT

D2791

21/03/201
1

20/03/202
1

GOC Certificate

MMD/DE
L/9276

03/08/201
5

02/08/202
0

Ratings Watchkeeping Cert

Ship
Handling
Manoeuvring

&

AMOS Windows / DOS

FRAMO experience

Yes

No

D. Sea Service Record

Rank

Vessel

Flag

IMO
Type

GRT

C/O

OCEAN
COLOSSUS

SGP

BULK

33183

2/O

WESTERN
OSLO

OSLO

BULK

31532

BULK

BHP

Period (DD/MM/YY)

Management

From

To

13/10/15

10/03/16

07/02/14

11/08/14

51201

23/12/12

20/06/13

FML

FML

FML

2/O

OCEAN
DIAMOND

2/O

STELLAR
CUPID

PAN

LOG/B
ULK

30146

28/07/12

31/10/12

FML

2/O

PACIFIC
PIONEER

HNG

BULK

38267

10/11/11

11/05/12

VRM

3/O

GLOBAL
TRIUMPH

MHL

BULK

38852

22/04/10

22/10/10

ASP

HNG

E. Information Sheet Chemical Tankers

Cargoes Carried: Tick Appropriate Box

DODECYLBENZENE (LAB)
HYDROGEN PEROXIDE
ACRYLONITRILE
SULPHURIC ACID
NITRIC ACID
PHENOL
EPICHLOROHYDRIN (ECH)

CONTROLLED

Revision: 01 Jan 2014

Approved by DPA/DMR
Page 3 of 8

TSM Form No. 070

Personnel Form

THOME
SHIP MANAGEMENT PTE LTD

CAUSTIC SODA
HEXANE
XYLENE
MDI / DIPHENYLMETHANE DIISOCYANATE
TOLUENE
METHANOL
PALM OILS
VEGETABLE OILS
MOLASSES
ETHYLENE DICHLORIDE (EDC)
STYRENE MONOMER
BENZENE
VINYL ACETATE MONOMER (VAM)
IPA / NBA
METHYL ETHYELENE GLYCOL (MEG)
LUB ADDITIVES / LUBRIZOL
LUB OIL
SODIUM HYDROSULPHIDE
PHOSPHORIC ACID
PROPYLENE OXIDE / ETHYLENE OXIDE
LIQUID NYLON
CONDENSATE
PARAFFIN WAX
GASOLINE
GASOIL
CONTROLLED

Revision: 01 Jan 2014

Approved by DPA/DMR
Page 4 of 8

TSM Form No. 070

Personnel Form

THOME
SHIP MANAGEMENT PTE LTD

JET A-1
NAFTA
HVGO
FUEL OIL
DIESEL OIL
RAFINERY SOYA BIN OIL
CRUDE SOYA BIN OIL
NITRATE SODIUM SOLUTION
OTHER INFORMATION / AREAS OF KNOWLEDGE: SCREW PUMPS
CENTRIFUGAL PUMPS
DEEP WELL PUMPS EXPERIENCE
SPECIALISED FRAMO COURSE
CLOSED LOADING / VECS.
CDI / CHEMICAL DITRIBUTION INSTITUTE
OIL COMPANY INSPECTION
USGC LETTER OF COMLIANCE
CARGO HEATING OIL/ STEAM/ DECK HTR.
TANK COATING TYPE Zn/ SS/ EPOXY
WALL WASH TESTING (HC/ CL)
PERMANGEMATE TESTING (PTT)
PASSIVATING STAINLESS STEEL TANKS
ISM / ISO
TRADE AREAS

CONTROLLED

Revision: 01 Jan 2014

Approved by DPA/DMR
Page 5 of 8

TSM Form No. 070

Personnel Form

THOME
SHIP MANAGEMENT PTE LTD

N2 PADDING
CARGO COOLING SYSTEM
OPA 90 TRAINING
ANY OTHER RELEVANT INFORMATION YOU WOULD LIKE TO INFORM US ABOUT:

F. Other Qualifications / STCW95 Courses

Course

Certificate No.

Date of Issue / Expiry

EFA

BPMA/E/45/2003

27/09/2003

BPMA/PSSR/847/2003

24/09/2003

PSSR
AFF

CMET/AFF/271/2
287

PSCRB

MMTI/PSCRB/68
47/2011

MFA

NATCOM/MFA/04
6/2011

MEDICARE

CMETD/SMC/000
9/0016

RUTC

CMETD/RUTD/00
27/0094

30/04/2011

26/02/2011

21/04/2011

25/09/2014

17/06/2015

English Language: Excellent

G. Bio Data

Height

Weight
183

87

Colour of Eyes

Colour of Hair

BLACK

GREY

H. Allotment and Social

Seamans Social Security Number

Individual Tax Number

CONTROLLED

Revision: 01 Jan 2014

Approved by DPA/DMR
Page 6 of 8

TSM Form No. 070

Personnel Form

THOME
SHIP MANAGEMENT PTE LTD

Allotee Family Name

Given Name

Relationship

Date of Birth

1.

Address

% Allotment

Bank/Branch

Account No.

Allotee Family Name

Given Name

Relationship

Date of Birth

2.

Address

% Allotment

Bank/Branch

Account No.

Allotee Family Name

Given Name

Relationship

Date of Birth

3.

Address

% Allotment

Bank/Branch

Account No.

I. Reference(s) from Previous Employment

No.

Company

Name of Contact Person

Tel/Fax

2.

3.

1.

J. Declaration and Signature

I hereby certify that the information given above are true and correct to the best of my knowledge and
belief. That I have not withheld any information that would affect my application unfavourably.
Any false declaration I supplied herein may constitute ground for disqualification and non-acceptance to
the company and can be further subjected to applicable penalties in accordance to existing laws governing

CONTROLLED

Revision: 01 Jan 2014

Approved by DPA/DMR
Page 7 of 8

TSM Form No. 070

Personnel Form

THOME
SHIP MANAGEMENT PTE LTD

the recruitment and employment of overseas seafarers.

Signature of Applicant

Date

K. Interview For Office Use Only

Interviewer

Date of Interview

Date Available

Recommended As

Date of
Contract

Comments

CONTROLLED

Revision: 01 Jan 2014

Approved by DPA/DMR
Page 8 of 8

First