Fal (OSM Crew Management ‘Approved by: | Managing Director Effectivity Date: | 03 Aug 2021 Document Title: | Beneficiary / Next of Kin Form Revision No: | OL Document ID: CRW - 29 Pages: 1 of Global Z Local EMPLOYEE DATA RECORD Employee No. 01862 Nationality: FILIPINO Date of ith: 3/14/1970 | Martal status: 1y Name: (as Fist Middle) VILLANUEVA,PEPITO NICOLAS. Place of Birth: COTABATO Malling Address: PUROK 3 LUINAB ILIGAN CITY 8200 Email Address: PP2.VILLANUEVA@YAHOO.COM Contact Numbers: +639476113541 BENEFIT FOR IMMEDIATE FAMILY MEMBERS ONLY: Designated Beneficiaries: (Person(s) who wil benefit rm the Pension Fund pan and Insurance Cove (se CBA Condition Incase ofl fife) NOEMI VILLANUEVA, Date of Birth: 1/16/1986 Address: PUROK 3 LUINAB ILIGAN CITY 9200 Contact Numbers: +639753630797 NEXT OF KIN DETAILS: ‘Next of Kis (Designated person tobe contacted for Seafarer’ matters) NOEMI VILLANUEVA Relation withthe Seafarer: WIFE une 14611986 _ Address PUROK 3 LUINAB ILIGAN CITY 9200 Contact Numbers: +639753630797 ) NUMBER OF DEPENDENT CHILDREN Name: eof ine 771472011 ethine TRISTAN CARL L VILLANUEVA Peet na ae Age: 12 Sex: M Pee ‘ASHLEIGH CAITE L. VILLANUEVA Date of rth: 9/1/2016 Age: 7 ‘Sex 3 Name: Date of Birth ee: Sex [Ram Date of ith Age: Sex: lancern, (ATURE OVER PRINTED NAME OF INSURED