Bernhard Schulte Ship Management India Pvt. Ltd.

NEXT OF KIN DECLARATION

NAME: EMP ID:

RANK:

VESSEL:

In the event of my death during my tenure on the above mentioned vessel, compensation payable if any, should
be paid to the following person/s as per the percentages indicated below whereas Balance of wages and personal
effects should be given to my next of kin whose name is declared in Sr. No. 1.
SR. DATE OF BIRTH CONTACT
FULL NAME RELATION ADDRESS PERCENTAGE
NO. (DD/MM/YYYY) DETAILS
1

Information Regarding Spouse and Children

NAME RELATIONSHIP GENDER DATE OF BIRTH (DD/MM/YYYY)

Candidates Signature: Date: _ Place:

Witness: ___ __
Fleet Personnel Manager/ Asst. Manager:
Sign & Stamp