Compliance Policy – Declaration by Crew Member

To

The Compliance Team

Elegant Marine Services Private Limited
401/A, Elegant Business Park,
Off Andheri - Kurla Road,
Near Kohinoor Continental Hotel,
Andheri (East),
Mumbai - 400 059

Dear Sir / Madam

I, Mr………………………………. holding Indian Passport

Number ........................................ am aware that during screening by Thomson Reuters data
base, as part of company’s compliance programme to ensure that there is no breach of
sanctions, there are potential matches against my name.

I confirm that none of the potential matches relate to me. I further confirm that I have not
been involved in any criminal or illegal activity and that I do not have a pending criminal
record.

If, whilst I am serving on the vessel, I am required to attend a police enquiry or my presence
is required before a court of law, I undertake to present myself before the police or court (as
the case may be) and I confirm that neither the company nor vessel owners / operators shall
have any liability. I further confirm that expenses attendant to my sign-off and for signing on
a replacement will be on my account and I agree to bear the same.

I hereby indemnify the Company and vessel owners / operators from all losses, expenses
and / claims they may suffer on account of any of the representations contained herein being
factually incorrect. Payment against the indemnity hereby granted shall be made by me
forthwith, upon receipt of a written demand by me from the company.

___________
(Signature)
Name of Seafarer:
Rank:
HKID:
Vessel Name:
Date:
Place: