CONFIDENTIAL

Covid-19 Vaccination Form

Name of Candidate Ni Kadek Intan Permani Dewi

Carnival UK requires all crew to be fully vaccinated against Covid 19.

COVID-19 vaccines and boosters are proven to be effective at reducing the risk of infection, serious illness,
hospitalisation and death from COVID-19. To ensure you continue to have the best protection against COVID-
19, and to protect those around you, we require that all crew joining any of our vessels are fully vaccinated with
a primary series of any WHO approved COVID-19 vaccination as a minimum. We highly recommend that all crew
are fully up to date with all available COVID-19 boosters when eligible.

A link of WHO approved vaccines can be found below:

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/covid-19-vaccines

We will continue to offer COVID-19 booster programmes on board, and during your time on board it will be
mandatory for you to attend these clinics to receive a booster vaccination or to formally record your refusal of the
booster in your medical records.

If you are offered a further booster on board during your tour, you will be issued with a vaccine card (NHS or
CDC). These vaccine cards may be internationally recognised, but we recommend you speak with your local health
authority to check. Non-UK nationals who have received a vaccine (full dose and/or booster) should not contact
the NHS requesting a certificate. Please contact the on-board medical team who will issue you a certificate.

Please note, for all crew who are planned to join a ship visiting Australia or Japan during their contract, they are required to
be fully vaccinated with a primary series and a WHO Approved booster (preferably MRNA) prior to joining the ship.

Thank you, for the vital role you’re playing in upholding these commitments, so that, together, we can keep ourselves and
each other as safe as possible.

Please select the correct option

I confirm I am partially vaccinated and agree to be fully vaccinated with a Primary series of any WHO-approved
COVID-19 vaccination prior to joining a CUK ship YES /NO
or
I confirm I am already fully vaccinated against Covid-19 with a Primary series of any WHO-approved vaccination
YES /NO
I can confirm I have also received a WHO-approved COVID-19 vaccination booster YES /NO

Date Signature

10/04/2023

By signing this form you are agreeing that you are currently fully vaccinated, or will be fully vaccinated, against Covid
19 with a Primary series of any WHO approved COVID-19 vaccination prior to joining our fleet (which must
have been administered at least 14 days before joining the ship).
 NEW HIRE – CONTACT DETAILS

First Name Ni Kadek Intan Permani

Surname Dewi
Home Address – Banjar Dinas Gunung sari, Desa Sepang Kelod, Kecamatan
You must have the right to remain
permanently in the country detailed in
Busungbiu, Kabupaten Buleleng, Provinsi Bali - Indonesia
your home address and will be
required to provide evidence of this.
This could a passport if you are a
national of the country, or a residence
permit/visa if you reside in a country
different to that of
your birth.
City Buleleng
Post / Zip Code 81154
Country Indonesia
Telephone Number 081337367542
Telephone Type Home / Mobile
Email Address intankadekpermanidewi@gmail.com

LANGUAGES

If you speak any of the following languages please indicate below by inserting
‘Yes’ into the appropriate box:

Language Basic Fluent

Cantonese
Chinese (Mandarin)
French
German
Italian
Japanese
Portuguese
Spanish
Russian
 Carnival UK – Consent to verify STCW Certificates with issuing provider

For the purposes of obtaining confirmation of authenticity from the issuing

training provider, I confirm that I consent to my STCW certificate details being
issued to the training provider to enable authentication to be obtained.

First Name Ni Kadek Intan Permani

Surname Dewi
Home Address Banjar Dinas Gunung Sari, Desa Sepang Kelod, Kecamatan
Busungbiu, Kabupaten Buleleng - Bali
City Buleleng
Post / Zip Code 81154
Country Indonesia
Date 10/04/2023
Signature
 Consent to Carnival UK STCW Policy and Requirements

I agree it is my responsibility to finance and obtain the STCW Basic Training

Certificates including Personal Survival Techniques, Fire Prevention & Fire Fighting,
Elementary First Aid, Personal Safety & Social Responsibilities prior to employment
commencing.

Date....10/04/2023..............................................................................

Name..Ni Kadek Intan Permani Dewi...............................................................................................

Signature............................................................................................

Carnival UK – Consent to verify STCW Certificates with issuing provider

For the purposes of obtaining confirmation of authenticity from the issuing training
provider, I confirm that I consent to my STCW certificate details being issued to the
training provider to enable authentication to be obtained.

First Name Ni Kadek Intan Permani

Surename Dewi
Home Address Banjar Dinas Gunung Sari, Desa Sepang Kelod, Kecamatan
Busungbiu, Kabupaten Buleleng - Bali
City Buleleng
Post/Zip Code 81154
Country Indonesia
Date 10/04/2023

Signature
Marlins Test - Consent Form

In addition to terms and conditions of employment stipulated by your employer, your

employment is also conditional on a number of criteria established by Carnival UK in
order towork on board our vessels. One of the criteria is to be in a possession of a valid
Marlins English Language Test.

As part of your application to work on board one of our vessels, you have been provided
witha unique license code which provides access to complete one Marlins Language
Test.
Please sign the below declaration giving your consent to Carnival UK to request
deduction ofthe relevant Marlins Test fee ($11 USD) from your employer. Your
employer will, upon receipt of our request, process a deduction from your first salary as
part of the Payroll process.

Please return to People Operations Cunard, Carnival UK, 100 Harbour Parade,
Southampton, SO15 1ST, UK, or e-mail scanned signed copy to
medical.recruitment@CarnivalUKGroup.com.

Declaration

 I give my consent to Carnival UK to request deduction of the Marlins English Language

Test fee from my employer

 I understand that the relevant fee will be deducted directly from my salary

 I agree to reimburse the Company the cost of the Marlins English Language Test fee if I
leave before joining one of Carnival UK vessels

Name: Ni Kadek Intan Permani Dewi ...................... Rank: H o t e l As i s s t a n t ..........................

Signed: .............................................................. Date: 10/ 04 / 2023 ......................................

Document Owner: Maritime Resourcing

Document Name: FORM – Consent to deduct Marlins English Language
Test Date: 8th October 2021
Version: 3.0
Page No: 1