412024, 11:36AM ‘Appendoc 1 COVID-19 Self Declaration Covidi9 Self Declaration Self Declaration By MUZAKKI . Name/Rank MUZAKKI. - Able Bodied Seaman Vessel Assigned/Visiting Hometown/City Office K, CONFIDENCE Bangkalan Contact Number/Alt Contact Number 81259988200 hitps:manning synergymarine inreletidocumentation/78626,oining_documents!appendix\_covid'9_self_dectartion 1842024, 11:36AM ‘Appendic 1 COVID-19 Sof Declaration + HAVE YOU TRAVELLED OUTSIDE YOUR CITY OR COUNTRY IN LAST 28 DAYS? Yes VI No rovide supporting comment Details supporting your answe! + DO YOU HAVE FLU-LIKE SYMPTOMS (E.G. FEVER, COUGH, SORE THROAT, SHORTNESS OF BREATH, NAUSEA, VOMITING ETC.)? Yes VNo Details supporting your answe! Details supporting your an: ~ DID YOU, IN THE PAST 14 DAYS, COME IN CLOSE CONTACT WITH SOMEONE WHO IS A CONFIRMED COVID-19 CASE ) Yes vNo Details supporting your answer Details supporting your an DID YOU, IN THE PAST 14 DAYS, COME IN CLOSE CONTACT WITH SOMEONE WHO IS FROM A COVID-19 HOT SPOT/RED ZONE AS PER LOCAL GOVT. Yes vr No Details supporting your answer Details supporting HAVE YOU BEEN INVOLVED IN PROVIDING DIRECT CARE FOR COVID-19 PATIENTS OR WORKING WITH HEALTHCARE WORKERS INVOLVED IN TREATING CORONAVIRUS PATIENTS? Yes a Details supporting your answer Details supporting your answer hitos:manning synergymarne inveledocumentation/78&26/oining_documentsappendix1_covis19_self declaration4120124, 11:36 AM ‘Appendix 1 COVID-19 Self Declaration https manning synergymarin invelietidocumentation/78626,oining_documents/appendiet_covid'9_self declaration4120024, 11:37 AM (M07 Next of Kin deciaration MO7 Next of Kin - Declaration Note toa seafarer: This ‘Next of Kin Declaration’ is pursuant to the provisions given under the sections 159A, ‘Nominations’, of the Merchant Shipping Act, 1958. According to this, a seafarer or an apprentice may nominate any one or more Persons. If a seafarer has a family, then for the purpose of nomination he may nominate any one or more of his family only. If a seafarer or apprentice acquires a family after he has made this nomination, thenthis nomination shall become void. In such a case, the seafarer will be required to make a fresh nomination. This is to further bring into the notice of the seafarer that the person or persons so nominated will have the right to collect the compensation amount from the employer as a trustee or a collector of such compensationamount. ‘Such nominee or nominees will not have the absolute right on the amount paid as compensation. The nominee will remain responsible to distribute the funds to the rightful claimants as per the Indian Succession ~ Act, 1925 or such other succession acts as may be prevalent at the time when such claim arises. By following the instructions as given in this Next of Kin Declaration form, the employer will discharge the liability of paying the compensation amount to the nominee or nominees in the proportions as determined by the seafarer, thereafter, shall not remain responsible to any other legal heir or lawful claimants in any manner. Having understood the above provisions as given in the law and as a matter of the company policy, the seafarer agrees to nominate the following persons to receive the compensation amount, if such a claim ever arises. Declaration By The Seafarer Name of the seafarer: MUZAKKI . Rank: Able Bodied Seaman Joining vessel name: K. CONFIDENCE In the event of my death or mental incapacity due to injury or illness, during my tenure on the above vessel, compensation payable if any, should be paid to the following person or persons as per the percentages indicated below. My balance of wages and personal effects should be given to my next of kin whose name appears first in the serial order. Note: + Ifthe seafarer or an apprentice has a family, then please enter one or more members of the family details only. + Ifthe seafarer or an apprentice does not have a family, then please enter the name of one or more persons as the next of kin> -ttpsvmanning syneraymarine.invreietidocumentation 78626/oining_documentsimO7_next_of_kin_dectaration 12; 4120124, 11:37 AM FAMILY DETAILS Noe 2akv~An fepaMiRan OPI 28041 748A wry, NaylA ALA 2aky 087853 4A 223 o% NATIS ATHAILLAH anky ox Signature of the witness: MOT Next of kin deciaation Bsn. jungariyae seLaTan eT Jew : 002 (20d DeshJundanyare ec. Seca EAS BANG es Wire Den UNGAYAR SELATAN PT/e0 2008/02 DS. QUIVEANAR feec .SocaH| PAB. BAND TAY Doucrter Den [UNGanraP- SELATAN 8%/~i0 | 002 Let OS JUNGANZDR ec. SOON kak fennel’ SON hitpsImanning synergymarine.iveieidocumentation!78826joining_documents/m07_next_of_kin_declaration 22SEFARER’S DECLARATION (PRE-JOINING) 1, * (A).Quality Policy and Drug and Alcohol Policy: As part of pre joining familiarization, i declare thati have been given access to company's Quality policy and Drug and Alcohol policy. I hereby declare that I have read, understood, and promise unreservedly to comply with Quality Policy and Drug & Alcohol policy of Synergy Group and the Owners of the vessel, during my entire tenure on the vessel. (71 Understand 2. * (B). Declaration of Joining Seafarer: I hereby confirm that I have not been requested by the Company or any other party acting on behalf of the company (manning agent and / or ship owner and / or manager and / or operator and /or agent and / or master of the vessel) to pay any fees or other charges, either directly or indirectly in part or in whole for gaining the subject employment. The only Possible costs I may be requested to bear during the recruitment process are the costs for the issuanceor renewal of my national certificate, my national seaman’s book, my passport, and any other similar personal travel document, excluding the cost of any visa which shall be paid by the Company or the ship ‘owner, I declare that I have been informed by the Company in advance about these possible costs 1 Understand 3. * (C)CBAs and Terms & Conditions: I have been given sufficient time to read the present employment agreement and Collective Bargaining Agreement applicable to the vessel. Furthermore, I declare that I have been properly informed and understood my rights and duties and other particular conditions applicable to my duties on board, including ship owner's policies and procedures, WT Understand 4, * (D). Grievance Redressal: I have also been briefed about the company grievance redressal mechanism/complaint procedures and one copy of the Safety & Familiarization booklet cot said procedures, has been handed over to me. 1 Understand 5. * (E). Duty to Report: I understand that it is my duty, and I am empowered to report any violation of Quality, D&A and Environment Protection Policy. I shall be vigilant and will report any violations of the above policies to the Master immediately upon my becoming aware of a violation. If appropriate actions are not taken to stop the violation, I am duty bound to report this at earliest to designated person(s) in the company. WT Understand ‘The above deciaration is truthful, and I willingly sign this without any duress. M-O8 A Edition No.1 / Rev.No.0 Date: 25 Nov 2022SEFARER’S DECLARATION (PRE-JOINING) Date: 20-Apr-2024 06:06 AM Place: Chennai M-08, Edition No.1 / Rev.No. Date: 25 Nov 202EMS AND MARPOL DECLARATION (PRE-JOINING) This is to confirm that I have read and understood the company’s Safety & Environment Policy and ‘Objectives on the Environment Management System. 1) Taking into consideration the consequences of violating Local, National and International Rules (such asbut not limited to US Act to Prevent Pollution from Ships, US Clean Water Act, EU Directive 2005/35, OPA 90, MARPOL Convention etc.) and other National or International Laws I confirm that: + Twill not participate in any illegal environmental practice while performing the duties assigned to me during my service on board the vessel. + Iwill continue to comply with the requirement set forth in the company's Safety and Environmental Protection Policy and instructions provided within the company’s Safety Management System. + Twill not permit any violation of environmental regulations, including but not limited to violation of Local, National, and international rules and regulations. Any violation or potential illegal activity related to environmental issues will be immediately reported to C/E, Master and to the office as soonas reasonably practicable after the activity becomes known to me. + There will be NO BYPASS line for hazardous materials ("hazardous materials" meaning emissions, discharges, or releases of hazardous or toxic chemicals, pollutants, contaminants, substances or wastes, petroleum, petroleum-based or petroleum-derived products, polychlorinated biphenyls, or radioactive material) exists in the Engine Room, in contradiction to the vessel's piping diagrams. + Oil Record Book entries will be truthful (C/E, C/O (Tanker) only).No + alterations will be made to vesse'’s piping. * Oily Water Separator will be maintained in good working condition, and I am fully familiar with its operation & no bypass piping exists. * Oily water separator will be maintained in accordance with maker's requirements. + The Incinerator will be maintained in good working condition and operated as necessary. I will familiarize myself with the operation of the incinerator. + Lunderstand the legal and environmental consequences of bypassing the Oily Water Separator. * Before the use of Oily Water Separator and Incinerator by engine key personnel, I shall inform the Chief Engineer. + Iwill ensure that all overboard valves are appropriately sealed/locked after operation. + OWS overboard valves padlock key log seal arrangements have been explained to me and I confirmunderstandi of key and relevant record keeping. * No flexible hoses will ever be used to connect tanks of oily wastes or oily water with vessel lines to permit illegal discharges overboard. + All sludge generated on board shall be directed strictly only to designated tanks. I + shall comply with the Garbage Management Plan that is implemented on board. M-08 Edition No.1 / Rev.No Date: 25 Nov 207EMS AND MARPOL DECLARATION (PRE-JOINING) 2) The following has been explained to me: * Zero-tolerance policy on non-compliance with Company Safety and Environment Protection Policy,SMS procedures and Environment Management System. Open and anonymous reporting system for reporting non-compliance with company policies, SMS procedures and Environmental regulations. + Falsification of records is an offence and may result in fines or imprisonment. Company's procedure for vessels calling United States to comply with CFR, VGP, OPA 90, CARB and local/port state requirements, Garbage Management Plan and Ballast Water Management Plan and requirement. * Operational status of MARPOL equipment on board. In case of a violation or non-compliance, the company will extend full co-operation to the authoritiesfor them to take necessary legal action. 1.* I declare that I shall always comply with the Company's Environment Management System procedures and will not hold the company responsible for any violations or non-compliances resultingfrom my actions or inactions. WT Understand Name MUZAKKI . Rank Able Bodied Seaman Vessel K. CONFIDENCE Date 20-Apr-2024 06:07 AM Place Chennai M-08 Edition No.1 / Rev.No Date: 25 Nov 207