LOMAR SHIPPING LTD.

Integrated Management System Manual 6

FORM C002: POLICY ACCEPTANCE, LIABILITY CLAUSE AND RESPONSIBILITIES ACKNOWLEDGEMENT
FORM

I, , employed by the Company to

serve onboard the vessel as

hereby declare that:

1. I have completed familiarization with Company’s IMS and policies which have been understood and I
will fully comply with them. I have been also briefed, understood and fully accept the Company’s
Business Ethics and the Bribery Act 2010, as amended, and I agree to comply with the Act’s provisions.
2. I am aware that Company’s policies constitute is the continuous improvement in terms of safety,
security, health, quality and protection of the environment and I confirm my intention to work towards
this direction.
3. I authorize any doctor, nurse, qualified medical technical, clinic, laboratory or medical facility appointed
by the Company, to collect blood, urine or breath samples from me for alcohol and drug screening, as
required during pre-employment and periodical examinations. This authorization is contingent on the
release of the test results to the employee if requested.
4. I authorize the release of medical information to the management of the Company. This authorization
is limited only to information regarding results and evaluation of all alcohol and drug screening tests
performed in connection with such tests. The use of this authorization is limited to assisting
Management in making an employment or administrative decision.
5. I am aware of all my responsibilities related thereof as well as of all my duties. In particular, I
understand and accept to fully adopt and implement all parts of policies/regulations related to my line
of service and agree to proceed with any actions under my responsibility to ensure that safety, security,
health, quality and the protection of the environment is maintained.
6. I am aware that the proper disposal of all oily wastes, including bilge and sludge, by the proper use of
the equipment on board the vessel or by discharging them ashore into appropriate reception facilities
is of very high importance. I am also aware that non compliance with above policies and procedures
may grant the Company liable for illegal breach of regulations and I will also be at risk of criminal
prosecution, which could result in my imprisonment. If I become aware of any problem that may lead
to or allow a violation of Company’s policies and procedures and international regulations, I shall
immediately contact the DPA.
7. I am aware of Company’s commitment to environmental protection which includes, but is not limited
to, the absolute and total prohibition of the use of “magic pipes” i.e. done secretly change to a vessel’s
waste-handling equipment, which allows waste liquids to be discharged in contravention of pollution
regulations.
I shall report immediately any use or suspicion of use of such prohibited “magic pipes” to the Master or
to contact the DPA or the COO.
8. I am aware that the Company does not provide any bonus for reducing operational, maintenance and
repairs for the machinery space systems, thus ensuring that employees will not sacrifice environmental
compliance in order to obtain a prescribed bonus.
9. I am aware that false entries in the Oil Record Book Part I as well as the Garbage Record Book and other
vessel’s logs is a violation of law, and will result in my dismissal.
10. I have provided the Company with accurate personal information (identification card, contact details,
address) as well as with all certificates and licenses which I hold, which are genuine.
11. I will not disclose any information, regarding projects, reports or any work carried for, or on behalf of
the Company, to anyone outside the employment of the Company, or anyone not involved with the
aforementioned work. Furthermore, I will not divulge any information to anyone, regarding confidential
files/documents, which I may be asked to read or work on for any work which I am involved in.
12. I will not photocopy or copy any documents/reports/books and electronic data without prior
permission.

Issue No.1 / Date: 15.06.2017 Revision No: .00 / Date: 15.06.2017 Page 1 of 2
LOMAR SHIPPING LTD. Integrated Management System Manual 6
FORM C002: POLICY ACCEPTANCE, LIABILITY CLAUSE AND RESPONSIBILITIES ACKNOWLEDGEMENT
FORM

MLC 2006:
13. All items contained in my Employment Agreement have been explained to me and I am aware of them.
14. A full sample Agreement incorporating all terms and conditions to apply (including the CBA) has been
provided to me prior to entering into the Agreement.
15. I was given adequate time to review the Agreement and seek advice on the terms and conditions
contained in it.
16. I freely entered into the Agreement with a sufficient understanding of my rights and responsibilities.
17. I was given an original set of my Seafarer’s Employment Agreement, which I must carry with me on
board (or a copy).
18. No fees or other charges for my recruitment or placement or for providing employment to me have
incurred directly or indirectly, in whole or in part.
19. No joining advances or any other exploitation has incurred with regard to the employment.
20. The Company’s Complaint procedure has been explained to me and I am fully aware of the process to
be followed and the record to be used.
21. The terms and conditions of employment and any particular conditions applicable to the job for which I
am engaged have been explained to me.

SIGNED
PLACE SIGNATURE DATE

Issue No.1 / Date: 15.06.2017 Revision No: .00 / Date: 15.06.2017 Page 2 of 2