Item
No. |
Ref No. as in crew agreement* |
Name in full as shown in certificate of competency* |
COE No. |
Next of Kin
- Name*
|
In What Capacity engaged* |
Amount of wages per calendar month |
Date of Birth*
(dd/mm/yyyy) |
Nationality*
|
COC No.
(issued by S'pore) |
Next of Kin
- Relationship* |
Date and Place of signing crew agreement* |
Others |
| 1. |
|
|
|
|
If others/supernumerary, please specify:
|
|
|
|
|
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore
|
Keep Watch On Board
Involved in Cargo Operations
|
| 2. |
|
|
|
|
If others/supernumerary, please specify:
|
|
|
|
|
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore
|
Keep Watch On Board
Involved in Cargo Operations
|
| 3. |
|
|
|
|
If others/supernumerary, please specify:
|
|
|
|
|
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore
|
Keep Watch On Board
Involved in Cargo Operations
|
| 4. |
|
|
|
|
If others/supernumerary, please specify:
|
|
|
|
|
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore
|
Keep Watch On Board
Involved in Cargo Operations
|
| 5. |
|
|
|
|
If others/supernumerary, please specify:
|
|
|
|
|
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore
|
Keep Watch On Board
Involved in Cargo Operations
|
| 6. |
|
|
|
|
If others/supernumerary, please specify:
|
|
|
|
|
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore
|
Keep Watch On Board
Involved in Cargo Operations
|
| 7. |
|
|
|
|
If others/supernumerary, please specify:
|
|
|
|
|
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore
|
Keep Watch On Board
Involved in Cargo Operations
|
| 8. |
|
|
|
|
If others/supernumerary, please specify:
|
|
|
|
|
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore
|
Keep Watch On Board
Involved in Cargo Operations
|
| 9. |
|
|
|
|
If others/supernumerary, please specify:
|
|
|
|
|
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore
|
Keep Watch On Board
Involved in Cargo Operations
|
| 10. |
|
|
|
|
If others/supernumerary, please specify:
|
|
|
|
|
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore
|
Keep Watch On Board
Involved in Cargo Operations
|
Item
No. |
Ref No. as in crew agreement* |
Name in full as shown in certificate
of competency* |
Particulars of Seamen Discharged, Desserted
or Otherwise Left The Vessel |
| Date & Place* |
Cause* |
| 1. |
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore |
|
| 2. |
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore |
|
| 3. |
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore |
|
| 4. |
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore |
|
| 5. |
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore |
|
| 6. |
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore |
|
| 7. |
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore |
|
| 8. |
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore |
|
| 9. |
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore |
|
| 10. |
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore |
|