Next of Kin Nomination & Consent Form: Section 1: Seafarers, N.O.K. & Children'S Details 1A: Seafarers Details

Form No. SC224 - Rev.: 3.0 Date: 04.06.
2018
NEXT OF KIN NOMINATION & CONSENT FORM

SECTION 1: SEAFARERS, N.O.K. & CHILDREN'S DETAILS
1A: Seafarers Details:
Family Name: TATARNIKOV First Name: VASILII
Rank: CENG D.O.B.: 24.06.1973
NOTES:
Nominated persons must be in compliance with the inheritance and other appropriate national laws. The document is valid as from the date stated in the form including
all subsequent assignments. It is your responsibility to provide any updated information to the Company in relation to the nomination of such individuals defined in
section 1B. This may also include changes to the contact information for persons nominated previously. A new form should be completed, signed and submitted under
these circumstances.
I hereby nominate the following individual (as stated in 1B) as the point of contact in case of an emergency and the beneficiary in case of a justified insurance claim. I,
the seafarer (as stated in section 1A) confirm that this consent form has been duly explained to the beneficiary (whose stated in section 1B) for their further
understanding, prior to them signing this form.
Signature: Place & Date:
1B: NOK Details:
Family Name: ZHYVAYKINA First Name: IRINA ALEKSANDROVNA

Title: D.O.B.: 15.10.1974
Relation to Seafarer: SPOUSE
Residence: APT. 29, 5 ANGELOV LANE
ZIP code: City: Moscow Country: RUSSIAN FEDERATION

Phone (Land Line): Mobile Phone no.: 7-978-832 80 32
Email: Fax no.:
1C: Children's Details:

The following information is required for insurance purposes:
No. of Children (presently under 21 years): 0
Specify D.O.B. of each child here:
SECTION 2: NOK, LEGAL PARENT/GUARDIANS CONSENT DECLARATION

For further information regarding our data protection policies and practices please read our Privacy Policy: https://marlow-navigation.com/en/privacy-policy.asp
For any GDPR enquires please contact: GDPR@marlow-navigation.com
Remarks: (to be reviewed and signed by the Next of Kin as stated in section 1B)
1. Please review the details stated in section 1B and the terms of the 'declaration of consent' below prior to signing this form
2. Proof of ID should be submitted with the form. A copy of any photo ID which bears your signature is acceptable
DECLARATION OF CONSENT
In accordance with regulation (EU) 2016/679 of the European parliament and of the council of 27 April 2016 on the protection of natural persons with regard to processing of
personal data and the free movement of such data and repealing directive 95/46 EC (GDPR). I hereby give my explicit consent for the company (as defined in the seafarers
employment agreement), to hold, process, store, transfer, transmit and use my personal information (as stated in this form) for the purpose of insurance claims made in light of an
incident (accident or illness). I acknowledge that I have the right to access such personal data as kept by the company about me and I have the right to correct such information
when appropriate evidence can be provided about the information being incorrect. I acknowledge my responsibility to provide any updated information to the company, which
requires my records held by the company to be-corrected. I understand that until the company receives written notification from me of any changes to be made, that the company
shall assume that all information they have about me in its records is correct. I understand that the company will provide, and submit my personal details to insurance companies
for the purpose of insurance claims made in light of an incident (accident or illness). I acknowledge that I am entitled at any time to withdraw my consent for any further
processing of my personal information held by the company in accordance with my rights under the law. Personal data collected about me will be adequate, relevant and limited
to what is necessary and will only be used for the purpose it was obtained. All personal data about me will be kept only for as long as is necessary and processed in a manner that
insures appropriate security against unauthorised or unlawful processing, accidental loss, destruction or damage, using appropriate technical or organisation measures. Further
information is contained in the company's data protection and privacy policies which will be made available to me once the company has this signed form. I understand that the
company is not prevented from disclosing my personal information when required or allowed to do so by law. This includes cases concerning national or public security,
commission, prevention of criminal offenses or legal proceedings. I hereby confirm that I have read, understood the above and agree to the company processing of my personal
information for reasons outlined above.
Full name of Signatory: NOK Signature: Place & Date:
COMPANY COLUMN REVIEWED
ENTERED
Once the form is filled in, the respective seafarer and the NOK should sign it.
A scanned copy of the signed form to be sent to the Crew Manager via email or Oracle (as appropriate)

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Form No. SC224 - Rev.: 3.0 Date: 04.06.

NEXT OF KIN NOMINATION & CONSENT FORM

Signature: Place & Date:

1B: NOK Details:

Family Name: ZHYVAYKINA First Name: IRINA ALEKSANDROVNA

ZIP code: City: Moscow Country: RUSSIAN FEDERATION

1C: Children's Details:

Specify D.O.B. of each child here:

SECTION 2: NOK, LEGAL PARENT/GUARDIANS CONSENT DECLARATION

Full name of Signatory: NOK Signature: Place & Date:

COMPANY COLUMN REVIEWED

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