Seamen Registration

 

wkwcs Awdm dig bs-33

Shipping Office Form No. 33

 

MYcÖRvZš¿x evsjv‡`k miKvi,

GOVERNMENT OF THE PEOPLE’S REPUBLIC OF BANGLADESH

‡bŠ-cwienY gš¿bvjq

 MINISTRY OF shippiNg

wbe܇bi Rb¨ Av‡e`bcÎ

APPLICATION FOR REGISTRATION

 

 

[ evsjv‡`k miKvi KZ©„K M„nxZ 2001 mv‡ji evsjv‡`k mgy`ª cwienb (bvweK wb‡qvM) wewagvjvi 6 bs wewa †gvZv‡eK ]

[Under Rule 6 of Bangladesh Merchant Shipping (Seamen’s Employment) Rules, 2001]

 

bvwe‡Ki d‡Uv

 

 

Seaman’s

Photograph

 

To,

wkwcs gvóvi,

PÆMÖvg|

            The Shipping Master,

                Chittagong.

 

 

g‡nv`q,

Sir,

        Avgv‡K bvweK wnmv‡e wbe܇bi Rb¨ Aby‡iva Kwi‡ZwQ  Ges cÖ‡qvRbxq Z_¨vejx wb‡gœ cÖ`vb Kwi‡ZwQ|

          I request for registration as a seaman and furnish the required particulars as under:- 

 

 

 

1|

 

bvg .........................................................

Name ................................................................

 

(eo Aÿ‡i)

(In Capital letters)

 

 

2|

 

(K)

 

wcZvi bvg .................................................

Father’s Name ...................................................

 

3|

Rb¥ ZvwiL ................................................

Date of Birth  ...................................................

 

4|

(L)

gvZvi bvg ..................................................

Mother’s Name .................................................

5|

wmwWwm bs ................................................

CDC NO. ..........................................................

Bmy¨K…Z ¯’vb I ZvwiL ..................................

Place & date of Issue .......................................

 

6|

RvZxqZv .............................

Nationality ..............................

 

7|

Wv³vix mb` bs .....................................

Medical Cert No. ........................................

Wv³vi KZ©„K cixwÿZ nIqvi †kl ZvwiL ................

Last examined date ...............................................

8|

wefvM ....................

Department ................

c`ex .....................

Rank ......................

 

 

 

8| ¯’vqx wVKvbv

     Permanent Address

 

MÖvgt- ................................

Village - .................................

WvKNit- ............................

P.O. .......................................

_vbvt- .....................................

Thana ..........................................

wRjvt-  ..................................

District .......................................

BDwbqbt- ....................

Uninion ........................

 

9| eZ©gvb wVKvbv

     Present Address

 

 

 

10| STCW Abyhvqx mb` mgyn

         stcw Certificates

 

mb` bs / Certificate No.

Bmy¨Kvix KZ©„cÿ/ Issuing Authority

Bmyi ZvwiL/ Date of Issue

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Avwg `„pZvi mwnZ ewj‡ZwQ †h Dc‡iv³ Z_¨vejx mZ¨,

I affirm that the particulars furnished above are correct.

 

ZvwiL

Date:-

 

Phone/Mobile:-

 

‡dvb/†gvevBj b¤^it-

 

 

 

 

Av‡e`bKvixi ¯^vÿi/wUcmwn

Signature/L.T.I. of the Applicant

 

(Aci c„óvq `ªóe¨)

                     

                       

 

-2-

 

gyj `wjjvw` I 3 Kwc d‡Uv mshy³ Kwi‡Z nB‡e| wVKvbv cwieZ©b nB‡j Awej‡¤^ RvbvB‡Z nB‡e|

Original Documents and 3 Copies of Photograph to be enclosed. Change in address, if any, should be promptly communicated.

 

bs ........................

No. ...........................             

 

wmwWwm bs ....................... `vwLj Kiv nBqv‡Q| Av‡e`bKvix Av‡e`b‡bi Rb¨ 15(cbi) Kg©w`em c‡i †LuvR wb‡eb|

CDC NO. ..................... deposit. The applicant should call after 15 (Fifteen) days for result of the application

 

 

 

 
 

wkwcs gvóvi, PÆMÖvg|

Shipping Master,

Chittagong.

 

 
 

ZvwiL

Date:-

 

 

 

 

 

 

 

 

wkwcs gvóv‡ii Av‡`kvejx

ORDERS OF THE SHIIPPING MASTER

 

 

wbeÜb Aby‡gv`b Kiv nBj

Registration Allowed.

 

 

wbe܇bi †h b¤^i †`Iqv nBj

Registration No. Allowed. ...................................

 

ZvwiL

Date:- ........................................................

 

 

 

 

 

 
 

wkwcs gvóvi, PÆMÖvg|

Shipping Master,

Chittagong.

 

 
 

 

 

 


wb¤œwjwLZ Kvi‡b wbeÜb evwZj Kiv nBjt-

Registration rejected for the resons given below:-

 

 

 

 

 

 

 

 

 
 

wkwcs gvóvi, PÆMÖvg|

Shipping Master,

Chittagong.

 

 
 

ZvwiL

Date:-.........................................