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NEXT OF KIN DECLARATION

Name of Seafarer : SHUKLA


RAHUL SHIVPRAKASH

Rank : 3/O

Vessel : DHT SUNDARBANS

Passport Number : Z3900416

Seaman Book Number : MUM150243

Details of Next-of-Kin:
Sr. Name Address Relationship Compensation
No. Percentage
Entitlement
1

2
3

Details of Children:
Sr. Name Date of Birth Gender
No.
1 Male / Female
2 Male / Female
3 Male / Female
4 Male / Female

Date: 28/11/2023

_______________________________ ____________________________
Signature of Seafarer Right Hand Thumb Impression

08.75.03.003.00 - NEXT OF KIN DECLARATION

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