Crew 16 - Next Of Kin Declaration

Name: Rank:
Joining vessel: Date:

In the event of my death during tenure on above vessel, compensation payable, if any, should be distributed to the
following person(s) as per the indicated percentages below. Balance of wages and personal effects should be given
to my next of kin that is first person in the following list.

No. NAME Relation Address / Contact details Percentage

Note: Provide telephone number of the NOK and not the telephone number of the seafarer. If
available, please provide more than one telephone number of NOK.

Information regarding spouse and children:

Name Relationship Date of Birth

I undertake to inform my above listed relatives that their personal data has been provided to the Company to use
in case of an emergency and they have a right of access to this data.

Signature: Date: Place:

Witness position and name

(Crewing dept):

Witness signature:

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Doc: Crew 16 Ver: 2 Issue: 1 Mar 2019 Use: As required File: Compas Retention: 1 Yr Page: 1 of 1