Form #07-5/5G BW INDIA - Next of Kin Rev No.

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Name of Joining Vessel’s

- PRASHANT KUMAR BW LESMES
Officer/Rating: Name:
Rank: 2ND ENGINEER Joining Date: 28 Mar 2023

I, the undersigned, hereby declare that in the event of my death during my tenure on the above mentioned vessel,
or any other vessel assigned by the Company during my current contract, the compensation payable, if any,
should be paid to the following beneficiaries as per percentages indicated against their names below.

My balance of wages and my personal effects should be given to the person in (1) below.

Name of Beneficiary / Date of Birth Relationship with seafarer Age Percentage

%

Rabindra Kumar Singh / 25 Jun 1964 FATHER 59 100.00

Signature: _______________________________________

Place: _______________________________________

Date / Time: 28 Mar 2023

Witness:_Pushpa//______________________________________ (Name and Signature)

In the event of an emergency the following NOK are to be contacted: ( FATHER) Rabindra Kumar Singh

Primary Contact Secondary Contact

Contact Numbers
(Home, Mobile, Email 9868488799
etc):
Record of Contact
Date/time contact was
made:
Reason for contacting:
Contacted by
(Name/Signature):