[DELTA TANKERS LTD ‘Eectve date: 017037200] FORM: MAN 09.4 Revision No.: 02 loftice Form Pages | FILIPINO SEAFARER’S EMPLOYMENT APPLICATION FORM OIL TANKERS PHOTO Main office C1 Manning Agent 2 code:[—_] TRegured Fels fstaeecrrciP C000) | [__Jrooness NAME NEXT OF [RELATIONSHIP [EMATL ADDRESS (If +t "HONE: AX OFFICE (8.0.¥) [stasses: [resopirocoermra—t— ——_* MEDICAL HISTORY [Have you ever suffered lines or Injury resulting tha disability of any Kind, permanent or temporary? Ir YES, brief description: — vs Ono ave you ever been mvcved Grey or rely an AGS reg hs of WE Or ROTA Ur Garage To Sp oF crgo po oer” Lares brie detalles IVES LINO[eran oar aeT [DELTA TANKERS LTD Eifecive date: 01/05/2021] FORM: MAN 09.1 0 Revision No.: 02, lorrice Form Page 3 teh Toons FoR OFFICE SEO JCREW : interview was conducted as per SMS 4.1 Interview was conducted as per SMS 4.2 [TECHNICAL : terview was conducted as per SMS 4.1 [OPERATIONS : terview was conducted as per SMS 4.1 {ENERAL MANAGER : Interview was conducted as per SMS 4.1 fiwrmoouceo sy: |Effective date: 01/03/2021 0 Revision No.: 02 Pages EDUCATION HISTORY PERIOD [SuBIECT FOREIGN LANGUAGES PROFICIENCY (SPEAK, READ, WRITE) (special focus n English which Is the working language) fz EXCELLENT LJ [VERYGOOD [] [s00p Cj [POOR C7 2 IEXCELLENT CJ |vERYGOOD [] [6000 Cj [Poor [1] A lExcetient-] _|veryoop CL) [6000 () _|PooR 1 HEREBY DECLARE THAT THE FACTS STATED IN THIS APPLICATION ARE TRUE TO THE BEST OF Mt KNOWLEDGE. 1 ALSO AGREE THAT ANY MISREPRESENTATION OR WITHHOLDING OF ANY INFORMATION WILL BE A GROUND FOR DENIAL OF MY APPLICATION AND TERMINATION OF MY EMPLOYMENT, IF ALREADY EMPLOYED. ~ SEAMAN'S SIGNATURE [CERTIFICATES AUTHENTICITY CHECK complete by the Manning Personnel Manager or the Manning Agent, when the recruitment is conducted by the Maing Agency and verified bythe Manning Manager. [Security Check conducted (where possible/ appropriate) Dsatisfactory O unsatisfactory satisfactory © unsatisfactory TRAINING NEEDS - FOR OFFICE USE ONLY [DEPARTHENT INTERVIEWED/APPROVED AE /STGHATORE lev ‘OPERATIONS MANAGER TEEEPTABLE ORE rma ves O TECHNICAL MANAGER oO o Go 0 “SAFETY MANAGERDPA MANN MANAGER (GENERAL MANAGERMMAI-DPA-008-19 REV: 00 / 14.03.19 \iiiy | Marsaman Manning Agency, Inc. coRsevr alo AUTHORIZATION FORA In order that we could assist you with your application as a seafarer and eventual employment with our duly accredited foreign principals, we may need to collect, record, and store your data and these data may include your personal & sensitive personal information. Please note that your personal information shall be handled strictly confidential and shall be protected by the Company security measures pursuant to Data Privacy Act (DPA) of 2012 and its implementing rules & regulations. In compliance with the law, we must ask for your permission to process your personal data for the purpose aforementioned. Kindly read the Data Privacy Notice in the next page before signing this form. For any further inquiries and/ or complaints, please address it to the Data Protection Officer, MR. PIOQUINTO G. FRIAS, through telephone no, 3181812 or you can email him at peps.acctz@marseman.ph for appropriate action, Declaration 4 of legal age, an applicant/ seafarer and a resident of have read and understood the contents of the Data Privacy Notice with respect to the processing of my personal data. | acknowledge that by signing this form, | confirm that | have given my consent to the processing of my personal data. | further acknowledge that | am fully aware of all the rights and obligations of the data subject under the Data Privacy Act of 2012, hereby voluntarily give my consent & authorization for the release of all the required personal information relative to my application as a seafarer & subsequent employment with the Company's foreign principals. ‘CONFORME: Printed Name & Signature Date:MMAI-DPA-009-19 REV: 00 / 14.03.19 Marsaman Manning Agency, Inc. DATA PRIVACY NOTICE MARSAMAN MANNING AGENCY, INC. (MMA) respects & upholds the privacy and security of personal information of its seafarers and employees. All personal information collected and processed by the Company are solely intended for the purpose explicitly stated. This Notice briefly explains the Company's personal data protection policies that are put in place to safeguard the personal information of the data subject. MMAI does not in any way divulge or release information to third parties or outside entities, except upon written consent or express approval of the owners thereof. As such, applicants/ seafarers are assured of paramount protection and full compliance with the law. ‘A-Collection, Use and Storage of Personal Data ‘The Company processes your personal data collected from you directly or indirectly such as from your previous Company, etc in order to consider your job application & these data may include your passport & identity, marital & contact information, training & education data, prior ‘employment information, health data & other special categories of personal data, criminal records, photo & any other personal information necessary for the evaluation of your application. The Company will use your personal data to process transactions for you for the following purposes. «To facilitate recruitment & placement for employment with MMAI as manning agent for and on behalf of its duly accredited foreign principals recognized by POEA; © For the administration of compensation and benefits, clients and governmental reportorial requirements, and other legal and expected business ~ related purposes; © POEA and government related agencies such as SSS, PHILHEALTH, PAG - IBIG, MARINA, etc. We share your personal information for the proper execution of processes related to the declared purpose & the use of your personal information is reasonably necessary, required or authorized by law. The intended recipients of the personal information shall include, but not limited to the following: POEA, embassies and consular office; MARSAMAN’s foreign principals duly accredited by POEA; Claims correspondents/ legal counsels/ taw firms; Accredited physicians, clinics, hospitals & insurers Your personal data shall be stored in an electronic database system called “KALYPSO”, and can be accessed only by authorized Company personnel. Hard copies of your data shall be filed in your 201 record & shall be stored securely in the office premises and can also be accessed by authorized personnel.MMAI-DPA-009-19 REV: 00 / 14.03.19 B=Retention Subject to applicable requirements of the OPA & other relevant laws and regulations, personal data should not be retained by the Company for a period longer than necessary, except for the following: The compliance of the Company with its legal obligations towards the competent authorities and/or third parties; ‘The duration of the legal consequences stemming from your application to the Other legal interest of the Company C= Rights You have the rights to: Withhold your consent at any time, but we cannot properly assist you in your application and/ or employment; Request access to your data & to information relating to the processing of your data by the Company; Request correction and/ or completion of your personal data; Object to the processing of your personal data, on the grounds relating to your particular situation; Request the Company to delete your data; File complaint before the competent data protection authority To exercise your rights, please contact the Data Protection Officer, MR. PIOQUINTO G. FRIAS, through telephone no. 3181812 or at his email address peps.acctz@marsaman.oh. 'D- Protection of Personal Information We take reasonable steps to make sure that the personal information we collect, use or disclose are accurate, complete and up to date; We keep and protect your personal information using a secured server behind a firewall & security controls; We keep your information only for as long as necessary for the fulfillment of the purposes for which the information was obtained or for the establishment of legal claims, or for the legitimate purposes as provided by law; We restrict access to your information only to qualified and authorized personnel only who handle your information with strict confidentiality; We let you update your information securely to keep our records accurate. CONSENT ‘The consent & authorization you have given here shall be understood as perr ission to ‘the Company to faithfully execute & perform the following acts or undertakings:MMAI-DPA-009-19 REV: 00/ 14.03.19 * To collect, record, organize, store, update or modify, retrieve, consult, use or consolidate all of my personal information in connection with the purpose stated above; * To furnish, provide, afford, or make available said information to any of its foreign principals, local representatives, claims correspondents and accredited clinics/ physician for proper evaluation and/or final approval of my application; * To maintain, upload, store or retain copies of the same information digital or otherwise for purposes of preserving my 201 file and other service records in case of successful application or employment with the Company. CONFORME: Printed name & signature Date: