To whom it may concern

STATEMENT

Objective – To ensure your safety during travel to/from the vessel

I, do hereby confirm my awareness regarding the risk of coronavirus infection and its possible
consequences (COVID-19), and my possible placement under quarantine during travel to and from
the vessel.

I am fully aware that my travel to my home country may get disrupted or extended due to
restrictions imposed by the airline or countries, including my home country.

I, hereby confirm that I am feeling healthy and do not have any COVID-19 symptoms like cough,
fever, breathing issue or any conditions which require immediate medical attention.

I, hereby confirm that I will strictly follow the precautionary guidelines to avoid coronavirus
infection while travelling (APPENDIX 1).

On my return to my home country, I will fully comply with the precautionary guidelines of the
local government. It is advisable to stay in self-isolation at home for a minimum period of 14 days. At
some locations, our office colleagues are operating from home. Hence it is advisable not to visit the
crewing office without a prior appointment.

This Statement has been issued by me in good mental health, sober mind, voluntarily, without
any constraint, influence and / or obedience.

This Statement has been made in English language.

I acknowledge that I understand the risk of the coronavirus infection and its possible consequences
(COVID-19). I further acknowledge that I have been reminded of the Company’s Safety Policy and
COVID-19 instructions and understand that it is my responsibility to comply.

Signature (or from seafarers recorded email) (or using Policy signing function in ShipSure):

………………………………………………………………………
APPENDIX 1

The World Health Organization advice on Coronavirus (COVID-19) is clear:

 When someone who has COVID-19 coughs or exhales they release droplets of infected fluid.
 Most of these droplets fall on nearby surfaces and objects - such as desks, tables or telephones.
 People could catch COVID-19 by touching contaminated surfaces or objects – and then touching
their eyes, nose or mouth. If they are standing within one meter of a person with COVID-19 they can
catch it by breathing in droplets coughed out or exhaled by them. In other words, COVID-19 spreads
in a similar way to flu.
 The risk of severe disease gradually increases with age starting from around 40 years.
 People with weakened immune systems and people with underlying medical conditions such as
cardiovascular disease, diabetes, chronic respiratory disease and cancer are more vulnerable to
serious illness.
Only a minority of people who get COVID-19 will develop complications severe enough to
require hospital care. In a small proportion of these, the illness may be severe enough to lead
to death.

To reduce the risk of catching the infection, the following precautions should be followed if in an area
where the virus is known to exist and to avoid being infected during travel:

a) Avoid physical contact with other persons particularly if they display any symptoms of COVID-19. No
handshaking, hugging or kissing.
b) Keep a social distance of 2 meters whenever possible.
c) If wearing a mask is mandated by local regulations, make sure to wear it properly by tightening up
the nose clip and pulling the bottom of it over your chin so that your nose and mouth are both
covered.
d) Frequently clean hands by using soap and water or an alcohol-based (> 65-70% alcohol) hand rub.
e) When coughing and sneezing, cover mouth and nose with a tissue or a flexed elbow.
Warning!
Throw tissue (if used) away immediately and wash hands.

f) Avoid touching the face including mouth, nose and eyes with unwashed hands (in case hands have
touched surfaces contaminated with the virus).