Item
No. |
Name in full as shown in certificate of competency* |
COE No./ROA No. |
Next of Kin(NOK)
- Name*
|
In What Capacity engaged* |
Amount of wages per calendar month |
1. |
|
COE No.
ROA No.
|
|
If others, please specify:
|
|
|
Date of Birth*
(dd/mm/yyyy) |
Nationality*
|
COC No.
(issued by S'pore) |
Next of Kin
- Relationship* |
Date and Place of engagement* |
Others |
|
|
|
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore
|
Keep Watch On Board
Involved in Cargo Operations
|
|
Passport No
|
Home Port (for Repatriation)* |
Recruitment Agent |
Contract Period* (In Months) |
The Shipowner, Manager, Agent or any person who is assuming the responsibilities of the Shipowner* |
|
|
|
Name of Company:
Country:
|
|
Owner
Manager
Employer
If you have selected 'Employer', key-in the below Employer Details.
Employer:
Employer Name:
Employer Email:
Address:
House No:
Block No:
Road 1:
Road 2:
Road 3:
Postal Code:
Country:
|
Item
No. |
Name in full as shown in certificate of competency* |
COE No./ROA No. |
Next of Kin(NOK)
- Name*
|
In What Capacity engaged* |
Amount of wages per calendar month |
2. |
|
COE No.
ROA No.
|
|
If others, please specify:
|
|
|
Date of Birth*
(dd/mm/yyyy) |
Nationality*
|
COC No.
(issued by S'pore) |
Next of Kin
- Relationship* |
Date and Place of engagement* |
Others |
|
|
|
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore
|
Keep Watch On Board
Involved in Cargo Operations
|
|
Passport No
|
Home Port (for Repatriation)* |
Recruitment Agent |
Contract Period* (In Months) |
The Shipowner, Manager, Agent or any person who is assuming the responsibilities of the Shipowner* |
|
|
|
Name of Company:
Country:
|
|
Owner
Manager
Employer
If you have selected 'Employer', key-in the below Employer Details.
Employer:
Employer Name:
Employer Email:
Address:
House No:
Block No:
Road 1:
Road 2:
Road 3:
Postal Code:
Country:
|
Item
No. |
Name in full as shown in certificate of competency* |
COE No./ROA No. |
Next of Kin(NOK)
- Name*
|
In What Capacity engaged* |
Amount of wages per calendar month |
3. |
|
COE No.
ROA No.
|
|
If others, please specify:
|
|
|
Date of Birth*
(dd/mm/yyyy) |
Nationality*
|
COC No.
(issued by S'pore) |
Next of Kin
- Relationship* |
Date and Place of engagement* |
Others |
|
|
|
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore
|
Keep Watch On Board
Involved in Cargo Operations
|
|
Passport No
|
Home Port (for Repatriation)* |
Recruitment Agent |
Contract Period* (In Months) |
The Shipowner, Manager, Agent or any person who is assuming the responsibilities of the Shipowner* |
|
|
|
Name of Company:
Country:
|
|
Owner
Manager
Employer
If you have selected 'Employer', key-in the below Employer Details.
Employer:
Employer Name:
Employer Email:
Address:
House No:
Block No:
Road 1:
Road 2:
Road 3:
Postal Code:
Country:
|
Item
No. |
Name in full as shown in certificate of competency* |
COE No./ROA No. |
Next of Kin(NOK)
- Name*
|
In What Capacity engaged* |
Amount of wages per calendar month |
4. |
|
COE No.
ROA No.
|
|
If others, please specify:
|
|
|
Date of Birth*
(dd/mm/yyyy) |
Nationality*
|
COC No.
(issued by S'pore) |
Next of Kin
- Relationship* |
Date and Place of engagement* |
Others |
|
|
|
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore
|
Keep Watch On Board
Involved in Cargo Operations
|
|
Passport No
|
Home Port (for Repatriation)* |
Recruitment Agent |
Contract Period* (In Months) |
The Shipowner, Manager, Agent or any person who is assuming the responsibilities of the Shipowner* |
|
|
|
Name of Company:
Country:
|
|
Owner
Manager
Employer
If you have selected 'Employer', key-in the below Employer Details.
Employer:
Employer Name:
Employer Email:
Address:
House No:
Block No:
Road 1:
Road 2:
Road 3:
Postal Code:
Country:
|
Item
No. |
Name in full as shown in certificate of competency* |
COE No./ROA No. |
Next of Kin(NOK)
- Name*
|
In What Capacity engaged* |
Amount of wages per calendar month |
5. |
|
COE No.
ROA No.
|
|
If others, please specify:
|
|
|
Date of Birth*
(dd/mm/yyyy) |
Nationality*
|
COC No.
(issued by S'pore) |
Next of Kin
- Relationship* |
Date and Place of engagement* |
Others |
|
|
|
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore
|
Keep Watch On Board
Involved in Cargo Operations
|
|
Passport No
|
Home Port (for Repatriation)* |
Recruitment Agent |
Contract Period* (In Months) |
The Shipowner, Manager, Agent or any person who is assuming the responsibilities of the Shipowner* |
|
|
|
Name of Company:
Country:
|
|
Owner
Manager
Employer
If you have selected 'Employer', key-in the below Employer Details.
Employer:
Employer Name:
Employer Email:
Address:
House No:
Block No:
Road 1:
Road 2:
Road 3:
Postal Code:
Country:
|
Item
No. |
Name in full as shown in certificate of competency* |
COE No./ROA No. |
Next of Kin(NOK)
- Name*
|
In What Capacity engaged* |
Amount of wages per calendar month |
6. |
|
COE No.
ROA No.
|
|
If others, please specify:
|
|
|
Date of Birth*
(dd/mm/yyyy) |
Nationality*
|
COC No.
(issued by S'pore) |
Next of Kin
- Relationship* |
Date and Place of engagement* |
Others |
|
|
|
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore
|
Keep Watch On Board
Involved in Cargo Operations
|
|
Passport No
|
Home Port (for Repatriation)* |
Recruitment Agent |
Contract Period* (In Months) |
The Shipowner, Manager, Agent or any person who is assuming the responsibilities of the Shipowner* |
|
|
|
Name of Company:
Country:
|
|
Owner
Manager
Employer
If you have selected 'Employer', key-in the below Employer Details.
Employer:
Employer Name:
Employer Email:
Address:
House No:
Block No:
Road 1:
Road 2:
Road 3:
Postal Code:
Country:
|
Item
No. |
Name in full as shown in certificate of competency* |
COE No./ROA No. |
Next of Kin(NOK)
- Name*
|
In What Capacity engaged* |
Amount of wages per calendar month |
7. |
|
COE No.
ROA No.
|
|
If others, please specify:
|
|
|
Date of Birth*
(dd/mm/yyyy) |
Nationality*
|
COC No.
(issued by S'pore) |
Next of Kin
- Relationship* |
Date and Place of engagement* |
Others |
|
|
|
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore
|
Keep Watch On Board
Involved in Cargo Operations
|
|
Passport No
|
Home Port (for Repatriation)* |
Recruitment Agent |
Contract Period* (In Months) |
The Shipowner, Manager, Agent or any person who is assuming the responsibilities of the Shipowner* |
|
|
|
Name of Company:
Country:
|
|
Owner
Manager
Employer
If you have selected 'Employer', key-in the below Employer Details.
Employer:
Employer Name:
Employer Email:
Address:
House No:
Block No:
Road 1:
Road 2:
Road 3:
Postal Code:
Country:
|
Item
No. |
Name in full as shown in certificate of competency* |
COE No./ROA No. |
Next of Kin(NOK)
- Name*
|
In What Capacity engaged* |
Amount of wages per calendar month |
8. |
|
COE No.
ROA No.
|
|
If others, please specify:
|
|
|
Date of Birth*
(dd/mm/yyyy) |
Nationality*
|
COC No.
(issued by S'pore) |
Next of Kin
- Relationship* |
Date and Place of engagement* |
Others |
|
|
|
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore
|
Keep Watch On Board
Involved in Cargo Operations
|
|
Passport No
|
Home Port (for Repatriation)* |
Recruitment Agent |
Contract Period* (In Months) |
The Shipowner, Manager, Agent or any person who is assuming the responsibilities of the Shipowner* |
|
|
|
Name of Company:
Country:
|
|
Owner
Manager
Employer
If you have selected 'Employer', key-in the below Employer Details.
Employer:
Employer Name:
Employer Email:
Address:
House No:
Block No:
Road 1:
Road 2:
Road 3:
Postal Code:
Country:
|
Item
No. |
Name in full as shown in certificate of competency* |
COE No./ROA No. |
Next of Kin(NOK)
- Name*
|
In What Capacity engaged* |
Amount of wages per calendar month |
9. |
|
COE No.
ROA No.
|
|
If others, please specify:
|
|
|
Date of Birth*
(dd/mm/yyyy) |
Nationality*
|
COC No.
(issued by S'pore) |
Next of Kin
- Relationship* |
Date and Place of engagement* |
Others |
|
|
|
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore
|
Keep Watch On Board
Involved in Cargo Operations
|
|
Passport No
|
Home Port (for Repatriation)* |
Recruitment Agent |
Contract Period* (In Months) |
The Shipowner, Manager, Agent or any person who is assuming the responsibilities of the Shipowner* |
|
|
|
Name of Company:
Country:
|
|
Owner
Manager
Employer
If you have selected 'Employer', key-in the below Employer Details.
Employer:
Employer Name:
Employer Email:
Address:
House No:
Block No:
Road 1:
Road 2:
Road 3:
Postal Code:
Country:
|
Item
No. |
Name in full as shown in certificate of competency* |
COE No./ROA No. |
Next of Kin(NOK)
- Name*
|
In What Capacity engaged* |
Amount of wages per calendar month |
10. |
|
COE No.
ROA No.
|
|
If others, please specify:
|
|
|
Date of Birth*
(dd/mm/yyyy) |
Nationality*
|
COC No.
(issued by S'pore) |
Next of Kin
- Relationship* |
Date and Place of engagement* |
Others |
|
|
|
|
|
Date (dd/mm/yyyy):
Place:
At Sea, long.
lat.
Elsewhere,
Singapore
|
Keep Watch On Board
Involved in Cargo Operations
|
|
Passport No
|
Home Port (for Repatriation)* |
Recruitment Agent |
Contract Period* (In Months) |
The Shipowner, Manager, Agent or any person who is assuming the responsibilities of the Shipowner* |
|
|
|
Name of Company:
Country:
|
|
Owner
Manager
Employer
If you have selected 'Employer', key-in the below Employer Details.
Employer:
Employer Name:
Employer Email:
Address:
House No:
Block No:
Road 1:
Road 2:
Road 3:
Postal Code:
Country:
|