Shell Australia Pty Ltd

Offshore Travel Data Collection Form

CONFIDENTIAL

Personal Information
All fields below are Mandatory
Surname (as per passport):
Forenames (as per passport):
Date of Birth:
Gender:
Nationality:
Company Name:
Job Title:
Home Base Airport:
Home Address:

Mobile Number:
Secondary Phone Number:
Email Address (work):
Email Address (personal):
Preferred email to receive travel itinerary:

Bi-Deltoid (shoulder) Measurement (cm):

Weight: (< or > than 140kg)
Emergency Contact Details
All fields below are Mandatory
Emergency Contact Surname:
Emergency Contact Forenames:
Home Address:

Mobile Number:
Secondary Phone Number:
HSSE Documents to be Provided
All documents below are Mandatory

For all offshore travel it is essential to fulfill all the HSSE training requirements.
Please provide a copy of the following documents together with this form:

• A coloured copy of both sides of an OPITO approved BOSIET card which states that an EBS / re-
breather module has been completed. The card should have an ID number & passport sized photo.
• A copy of your Fitness to Work Certificate.

DATA PRIVACY STATEMENT

Shell Australia Pty Ltd is collecting the above information to facilitate the movement of people and material for
offshore operations. The above information will be processed for logistics purposes including identification prior to
travel, calculation of helicopter payload, generation of flight manifest with passenger details, validation of HSSE
mandatory trainings and tracking of persons on board in offshore locations including in emergency situations. Any
other use we make of this information will be to support this primary aim.

We refer you to Shell’s privacy policy available at: https://www.shell.com.au/privacy.html which governs Shell’s
management of personal information and your rights in that regard.

If there are any questions regarding the Shell Privacy Policy or the way that Shell manages personal information
or if there are any concerns about Shell's treatment of personal information, then Shell should be contacted:

Shell Privacy Officer

PO BOX A47 CDC
Perth WA 6000
Telephone: +61 8 9338 6000

If you are unsatisfied with the handling of your personal information by Shell, then you have the right to lodge a
complaint to:

Office of the Australian Information Commissioner

GPO Box 5218
Sydney NSW 2001
Phone 1300 363 992
Visit oaic.gov.au

SIGNATURE: E-signatures accepted

X

DATE: ________/__________/__________

Naming convention: Data Privacy Forms should be saved in consistent naming convention prior to sending to
Shell Australia for processing. Naming convention below;

LASTNAME_Firstname_Shell Data Privacy Form_Date Completed

Example: SMITH_Trevor_ Shell Data Privacy Form_20-Jul-2017

Storage of Data Privacy Forms: Data Privacy Forms must be retained by Shell Australia as per the Shell
Australia People Movement Procedure, the completed form must be emailed to, or accessible to Shell Australia
prior to dispatch.