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Seamen Application Form - INTERORIENT

The document is an application form for seamen, requiring personal information such as name, nationality, contact details, and next of kin. It includes sections for languages, vaccinations, visas, seaman book, passports, certificates, sea service, and licenses & endorsements. Mandatory fields are marked with an asterisk, and specific date formats are required.

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marioemad29
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3 views4 pages

Seamen Application Form - INTERORIENT

The document is an application form for seamen, requiring personal information such as name, nationality, contact details, and next of kin. It includes sections for languages, vaccinations, visas, seaman book, passports, certificates, sea service, and licenses & endorsements. Mandatory fields are marked with an asterisk, and specific date formats are required.

Uploaded by

marioemad29
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

INTERORIENT APPLICATION FORM - Seamen

Applicant: ,

*Date of Application: Manning Agent:


To be filled in by the INC Representative

APPLICANT

*Surname: *Nationality:

*First/Middle Names: Birth Place:

*Date of Birth: *Rank:

ADDRESS

Nearest Airport: Tel:


*Address: Mobile:
*City: Fax:
*Country: E-mail:
ZIP:

NEXT OF KIN

Marital Status: Spouse's Name: No of Children:

KIN Surname: KIN Address:


KIN Forename: KIN City:
KIN Relation: KIN Country:
KIN Telephone: KIN ZIP:
If address as above, please leave these fields empty

LANGUAGES MEASURES

Level of English: Height (cm):

Mother Language: Weight (kg):

Other Language: Safety Shoes Size:

VACCINATIONS (Please insert Date)

Yellow Fever: Cholera: Typhoid:

Tetanus: Hepatitis B:

VISAS
*Description Date Issued Date Expiry Country Number

SEAMAN BOOK
*Book No Nationality Country Date Issued Date Expiry

PASSPORTS

*Passport No Type Country Date Issued Date Expiry

1. Fields marked with * are mandatory

2. Date Format: DD/MM/YYYY Page 1/4


INTERORIENT APPLICATION FORM - Seamen
Applicant: ,

CERTIFICATES
*Description Number Date Issued Date Expiry Country

SEA SERVICE
*Date From Date To Rank Vessel Name DWT HP Engine Vessel Type Company Flag

Page 2/4
INTERORIENT APPLICATION FORM - Seamen
Applicant: ,

LICENSES & ENDORSEMENTS

*Description Nationality Rank Number Date Issued Date Expiry Country Limitations
Lic' 1
Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry
End's
1 - 10
*Description Nationality Rank Number Date Issued Date Expiry Country Limitations
Lic' 2
Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry
End's
1 - 10

*Description Nationality Rank Number Date Issued Date Expiry Country Limitations
Lic' 3
Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry
End's
1 - 10

*Description Nationality Rank Number Date Issued Date Expiry Country Limitations
Lic' 4
Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry
End's
1 - 10

*Description Nationality Rank Number Date Issued Date Expiry Country Limitations
Lic' 5
Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry
End's
1 - 10

*Description Nationality Rank Number Date Issued Date Expiry Country Limitations
Lic' 6
Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry
End's
1 - 10

*Description Nationality Rank Number Date Issued Date Expiry Country Limitations
Lic' 7
Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry
End's
1 - 10

*Description Nationality Rank Number Date Issued Date Expiry Country Limitations
Lic' 8
Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry
End's
1 - 10

*Description Nationality Rank Number Date Issued Date Expiry Country Limitations
Lic' 9
Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry
End's
1 - 10

*Description Nationality Rank Number Date Issued Date Expiry Country Limitations
Lic' 10
Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry
End's
1 - 10

Page 3/4
INTERORIENT APPLICATION FORM - Seamen
Applicant: ,

LICENSES & ENDORSEMENTS (cont.)

*Description Nationality Rank Number Date Issued Date Expiry Country Limitations
Lic' 11
Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry
End's
1 - 10

*Description Nationality Rank Number Date Issued Date Expiry Country Limitations
Lic' 12
Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry
End's
1 - 10

*Description Nationality Rank Number Date Issued Date Expiry Country Limitations
Lic' 13
Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry
End's
1 - 10

*Description Nationality Rank Number Date Issued Date Expiry Country Limitations
Lic' 14
Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry
End's
1 - 10

*Description Nationality Rank Number Date Issued Date Expiry Country Limitations
Lic' 15
Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry Nationality Date Expiry
End's
1 - 10

COMMENTS

Page 4/4

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