APPLICATION Exn. 2 (Pak)

FOR

MASTER MARINER AND DECK OFFICERS EXAMINATIONS

Note: - Application should be made at Mercantile Department Karachi, It should be submittedalong with certificates of short courses as in NOE or Mark Sheet ( if candidate is appearing for re-examination ) within

10 days before closing dategiven in annual schedule of that year.

(A)Particulars of Applicant

Name in Full (Block Letters) / Resident Address
Date of Birth / Place of Birth / Nationality
Seaman Book No. / Mobile No.

(B)Previous Certificates (issued in Pakistan or elsewhere, if none; state so)

Title of Certificate / Certificate Number / End. No. / Date of Issue / Date of Expiry / State whether at any time suspended or cancelled and if so: -
(a) By what Court of Authority
(b) Date (c) Cause
Class II /III/ IV
Please delete as appropriate / (a)
(b)
(c)

(C)Examination now required

Please tick the appropriate box; / Port at which Applicant desires to be examined and Date
Class-1
Orals
 / Class-II
Block A Block B Orals
   / Class III
Written Orals
  / Class IV
Written Orals
  / KARACHI /

(D)Certificate of Principal Officer

The Declaration (F) was signed in my presence, and the Fee of Rs. ______was received by me.

…………………………20…………………………………Principal Officer

(E)Certificate of Examiner Mercantile Marine Department, Karachi

Sight Test / Written
Block A Block B
Class III Class IV / Oral / Signaling / Additional sea service (If any) / Certificate of Competency
to be issued
Date / Letter Test / Lantern Test

…………………………20……………...……………Examiner

(F)Declaration to be made by Candidate

(TAKE NOTICE-Any person who makes, or procures to be made, or assists in making, any false representation for the purpose of obtaining for himself or any other person, a certificate of Competency will render himself liable to heavy penalties.)

I hereby declare that the particulars contained in Sections (A), (B) and (C) of this Form are correct and true to the best of my knowledge and belief. And I make this Declaration conscientiously believing the same to be true.

…………………………..20…… ………………………………….

Signature of Candidate