Veritas Maritime Training Centre S.R.L.

111 Ion Lahovari Street, Constanta 900588, ROMANIA

TEL: +40736367688, EMAIL: info@vmtc.ro

DECLARATION OF CONSENT FOR SEAFARERS

Full Name
Date of Birth (DD/MM/YYYY)
Home Address

E-mail Address

A. I, the undersigned seafarer, hereby acknowledge and confirm that I have been duly informed of the
provisions of national and European law, and of the rights established concerning the protection of my
personal data.
B. Having done so, I hereby acknowledge and, without any reservation, agree in a lawful, fair and transparent
manner to process my personal data already provided or that will be provided in the future to the manning
agents for recruitment and employment purposes, including payroll/allotments, insurance and social
security, training, flag endorsements, travel arrangements and claims handling.

Specifically, I hereby freely consent, without any reservation, to:

1. Process my personal data, including but not limited to: name, photo, date and place of birth, postal
addresses, e-mail, IP address, telephone numbers, family status, passport and other identification
documents, employment history and work performance records (CV, appraisal reports, video/audio
interview recordings, professional references), bank account details of the beneficiaries/allottees, next of
kin’s contact and other personal details, tax and social security identification numbers, school degrees,
certificates of competence and training, as well as any other information included in the employment
contract;
2. Process any special types of data that refer to my ethnic origin, religion, criminal records, health, medical
records and examinations;
3. Pass my personal data on to third parties: manning agents, vessel’s managers/owners, flag state, training
centers, visa agents, travel agents, foreign embassies and public authorities, port agents, medical clinics,
P&I Clubs, insurance companies, and banks based in my country of origin, Europe or third-party countries
that jurisdictions may not provide equivalent protection with national and European law; and
4. Store my personal data on a database for as long as rights/obligations/claims arising from the recruitment
and contract of employment and/or any other contractual relationship remain in force.

Place: Date (DD/MM/YYYY):

Full Name: Signature:

WITHDRAWAL OF CONSENT FOR SEAFARERS

I hereby withdraw my consent given above, and acknowledge that it shall not affect the lawfulness of any process
conducted before the withdrawal.
Place: Date (DD/MM/YYYY):

Full Name: Signature: