ISWAN HARDSHIP FUND

(SMALL GRANTS FOR PHILIPPINE REGION)

Please indicate: __ Seafarer ___ Not Seafarer (relationship: _____________________)

1. PERSONAL INFORMATION
Given name Surname Suffix

Date of Birth Contact No/s Email Address

Home Address

If you are a seafarer, please provide the information below

2. WORK INFORMATION
What is your Rank? Passport No SIRB

What is the name of your ship? What is its Flag? What is the IMO no of the ship?

What is the type of the Ship Under what manning agency you are engaged with? (previous/present)

How many years you are now as a seafarer? Are you a member of a Union?

3. WHAT IS YOUR SITUATION?

Please provide a short explanation of the situation or your need. Kindly include how and when it happened.

Small Grants Application Form | pg. 1/2

 4. HOW MUCH AND WHERE WILL YOU USE THE GRANT?
This should explain how the grant help you resolve your situation.

5. WHOM HAVE YOU APPROACHED TO MEET THIS NEED?

Please provide information on whom you ask for help aside from ISWAN to meet this need. Kindly include the name of the person, maritime
welfare organisation, government agencies, companies, social securities programs that you have been approached and the updates.

6. STATEMENT
I, which name and signature is appeared below have provided all the information as true and correct based on my knowledge and capacity.
As applicant of this grant, I understand that the approval is solely in the discretion of the appointed advisers for this grant and the regional
office of ISWAN has nothing to do with the decision nor can influence the advisers to approve it.

Printed name and Signature: Date:

For ISWAN-Philippines use:

7. TOTAL AMOUNT REQUESTED

Amount Currency Grant to be paid in:

8. LIST OF SUPPORTING DOCUMENTS PRESENTED BY THE APPLICANT

The request of grant should be accompanied with documents as proof of legitimacy of the concern/need. Applicant must submit scan copies
of them according to the order it was listed below.
1.
2.
3.
4.
5.

Small Grants Application Form | pg. 2/2