Seaman Application Form

Please fill out the application form completely and accurately.

Personal Information

First Name *

Last Name *

Email Address *

Phone Number *

O T H E R N A T I O N A L I T Y / A D D I T I O N A L D O C U M E N T S

E N D O R S E M E N T					S E A M A N ' S B O O K
No	NATIONALITY	NUMBER	ISSUE	EXPIRE	No	NATIONALITY	NUMBER	ISSUE	EXPIRE
1					1
2					2

OTHER DOCUMENTS	ISSUE DATE	EXP. DATE
YELLOW FEVER CARD NO:
USA VISA NO:
MCV VISA NO:

PREVIOUS SEA SERVICES

(please insert the last five voyages in chronological order, starting with the last one)

NAME OF THE VESSEL	YEAR OF BUILD	RANK	TYPE	DWT	OWNER/MANAGER	ENGINE TYPE/HP	FROM	TILL

BANK DETAILS NOMINATED:

BANK'S NAME:

ACCOUNT HOLDER:

IBAN CODE:

SWIFT CODE:

DECLARATION

I, the undersigned, hereby certify that I have furnished all above information in good faith with the purpose of employment with your Company and that all the data is true and can be proven against my original documents (Passport, Seaman's book, professional certificates of discharge), which I will produce at any time upon request by employing office, Master, Shipping Company and/or authorized authority. Should any discrepancy from above stated arise, I will be fully responsible for the resulting consequences, including, but not limited to, full charges and costs caused by such fact to involved parties for my employment and for immediate repatriation from the ship.

I agree to the declaration stated above. *

SEAMAN'S SIGNATURE

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