Seafarer Details
| First Name | |
Last Name | |
| Date of Birth | |
Place of Birth | |
| Rank | |
Vessel | |
| Nationality | |
Marital Status | |
| Passport No | |
SMB Number | |
| Address | |
| Contact | Ph: | Email: |
I hereby declare the below mentioned as my Next of Kin:
| S/n |
Name |
Relationship |
Date of Birth |
% to be allotted |
| 1 | | | | |
| 2 | | | | |
Details of children below 18 years
| Name |
Gender |
Date of Birth |
Address |
| | | |
| | | |
I confirm that the above information is correct. In case of any changes, I will notify the Company immediately.
The allotment percentage specified above is my voluntary decision for the remittance of my wages.
Place & Date
Seafarer's Signature