Reference Number:

MARINER’S NATIONAL INSURANCE QUESTIONNAIRE

For The Period From 6th April '20 To 5th April '21

Part 1 – Contact Details

National Insurance Number J T 2 6 5 1 1 1 D

Surname / Last Name GUNN
First Name(s) ALISTAIR
Date of Birth 07 NOV 1982

Address 7204, 119th ST NW

EDMONTON, ALBERTA, CANADA

Postal Code T6G 1V6

Telephone Number / Mobile Number +1 780 850 4856 / +44 131 463 2352

E-mail Address ALISTAIR.GUNN@gmail.com

Is the address quoted above your normal place of residence Yes x No

Part 2 – Questions for completion

Please answer the following questions for each voyage and you must provide copies of, any signed
contracts, your discharge book and any relevant payslips/P60’s so that a decision can be made.

Q1 What are the dates that you want us to investigate? APRIL 2020 - APRIL 2021

Q2 Are you an oil rig worker? Yes X No

Q3 What are the name(s) of the ship(s) that you were COSL PIONEER BORR NJORD BORR GALAR
on during this period?

Q4 What type of vessel(s) is it? e.g. passenger cruise M.O.D.U. M.O.D.U. M.O.D.U.
liner, container ship.

Q5 What flag does the ship(s) fly?

SINGAPORE PANAMA PANAMA

Q6 What was the port(s) of registry? SINGAPORE PANAMA PANAMA

Q7 What is your job/position on the vessel(s)? COACH ADVISOR ADVISOR

Q8 Did you sign a crew agreement? Yes / No Yes / No Yes / No

Q9 Where , when and how did you agree to PHONE / EMAIL PHONE / EMAIL PHONE / EMAIL
commence work for your employer / enter into
contract of employment? WEEKS
WEEKS
WEEKS BEFORE
(e.g. over the phone, by fax, office in the UK, on BEFORE
BEFORE DEPLOYMENT
DEPLOYMENT
board ship and in which port, etc.) DEPLOYMENT

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Q10 Please provide the full name and address of the

COSL, VESTRE BORR DRILLING, E. PEARMAN
owners of the ship(s) or rig. Please also provide SVANHOLMEN BLDG. HAMILTON HM11,
the name and address of the operator of the 4, SANDNESS BERMUDA
ship(s) or rig if this is different from the name and
address of the owner.

Q11 Do they have a place of business in the UK? Yes / No Yes / No Yes / No

Q12 Please provide the full name and address of your COSL: TSG PERTH, SPOUTWELL HOUSE, PERTH, PH26RN
employer, as named on your contract of
employment.

BORR WORK: SALOS SUNESIS LTD, HILL OF RUBISLAW,

ABERDEEN, AB156FZ

Q13 Does this company (your employer) have a place of business in the UK? Yes X No

Q14 Is this the head office? Yes X No

Q15 If you were employed through a third party (such

as a crewing agency) and this company is not the
employer on your contract, please provide their
full name and address.

Q16 Please provide the full name and address of your GUNN-BBL ENERGY SERVICES,
payer of wages.
71-75 SHELTON ST, COVENT

GARDEN, LONDON, WC2H 9JQ

Q17 Does your payer of wages have a place of business in the UK? Yes X No

Q18 Is this the head office? Yes X

No

Q19 In which area are you mostly employed? ROUGHLY 50/50 BETWEEN NORTH SEA, EAST
e.g. North Sea, Caribbean, Deep Sea
If North Sea which sector? If you are mostly OF ABERDEEN, AND GULF OF MEXICO (BORR)
employed in the North Sea please give details of
which sector(s) you have worked in, together with
the dates.

Q20 If you have incorrectly paid Class 1 National Insurance Contributions you may, Yes No
X
in certain circumstances, be entitled to pay voluntary Class 2 contributions
instead to protect future benefit & pension entitlement. If your particular
circumstances do entitle you to pay voluntary Class 2 contributions, would you
like us to offset this amount against any refund due?

Signature: Date:

Please note all completed questionnaires should be returned to:

HM Revenue and Customs, Local Compliance, Marine Group S0970, Newcastle, NE98 1ZZ, United Kingdom

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