No: C - 28

POSEIDON SA Page:
Date:
1 of 1
01/12/15
Rev.: 0

MLC DECLARATION FORM

Yes No
All items contained in my employment contract have been explained to
1.
me and I am aware of them.
A full sample agreement incorporating all terms and conditions to apply
2. (including the CBA) has been provided to me prior to entering the
agreement.

I was given adequate time to review the contract and seek advice on the
3.
terms and conditions in the agreement

I freely entered into the agreement with a sufficient understanding of my

4.
rights and responsibilities.

I was given an original set of my Seafarers Employment Agreement,

5.
which I must carry with me on board.

No fees or other charges for my recruitment or placement or for providing

6.
employment to me have incurred directly or indirectly, in whole or in part.

No joining advances or any other exploitation incurred with regard to the

7.
employment.

The companys Complaint procedure has been explained to me and I am

8.
fully aware of the process to be followed and the record to be used.

The terms and conditions of employment and any particular conditions

9.
applicable to the job for which I am engaged have been explained to me.

Companys procedure for early repatriation and minimum notice period

10. (twenty days) has been explained to me and I am fully aware of the
process to be followed.

By ticking the YES box you indicate that the documented statement is correct.
By ticking the NO box you indicate that the documented statement is NOT correct.
If any statement is answered NO you may enter your remarks below.

Remarks:

Seafarers Name Rank Vessel to join