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: Sign & Stamp Fleet Personnel Manager/ Asst. Manager: