CREW INFORMATION FORM

First Name: Sur Name:

Rank/Post: Nationality:

Permanent Address: Current Address:

Date of Birth: Age:

Height: Weight:

Coverall Size: Shoe Size:

Religion: Next of Kin:

Contact No.:
Details of NOK:
E-mail:

DOCUMENTS NUMBER

Passport

Seaman Book

COC NUMBER

COC
COE

[Endorsements]

[Endorsements]

[GMDSS]

STCW CERTIFICATES NUMBER

Fire Prevention and Fire Fighting

Personal Survival Techniques

Personal Safety and Social
Responsibility

Elementary First Aid

SAT or SDSD (Security Awareness)

DP Operator Certificate

Radar Observer & ARPA

ECDIS (if applicable)

Advance Fire Fighting

Survival and Rescue Craft

FRC (Fast Rescue Craft)

Medical Care

Advance First Aid

SSO
[INSERT PHOTO]

DATE OF PLACE OF
DATE OF ISSUE
EXPIRY ISSUE

DATE OF PLACE OF
DATE OF ISSUE EXPIRY ISSUE

DATE OF PLACE OF
DATE OF ISSUE
EXPIRY ISSUE
 Sea Service History
VESEEL Information Operation
Vessel Name Rank Type / Eng.
GRT / HP / Type of
Make / Propulsion
KW Operation
Sea Service History
Operation Duration
Company
Area of Operation Client Sign-on Sign-off No. Of DAYS