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    Postsea Common Application PDF

    Uploaded by

    Ashirwad Behura
    This document is an application form for training courses offered on the Training Ship Rahaman. It requests personal details of applicants such as name, nationality, date of birth, certification numbers, and shipping company. The applicant must declare that any valuables brought are at their own risk and absolve the training ship of liability. The applicant also agrees to indemnify the training ship from injury claims and consents to emergency medical treatment, paying associated costs. Contact information of a next of kin is also requested. The bottom section is for office use only, to record fees paid and certificate/residential status.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Postsea Common Application PDF

    Uploaded by

    Ashirwad Behura
    27 views1 page
    This document is an application form for training courses offered on the Training Ship Rahaman. It requests personal details of applicants such as name, nationality, date of birth, certification numbers, and shipping company. The applicant must declare that any valuables brought are at their own risk and absolve the training ship of liability. The applicant also agrees to indemnify the training ship from injury claims and consents to emergency medical treatment, paying associated costs. Contact information of a next of kin is also requested. The bottom section is for office use only, to record fees paid and certificate/residential status.

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    postsea_common_application.pdf

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    This document is an application form for training courses offered on the Training Ship Rahaman. It requests personal details of applicants such as name, nationality, date of birth, certification numbers, and shipping company. The applicant must declare that any valuables brought are at their own risk and absolve the training ship of liability. The applicant also agrees to indemnify the training ship from injury claims and consents to emergency medical treatment, paying associated costs. Contact information of a next of kin is also requested. The bottom section is for office use only, to record fees paid and certificate/residential status.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    27 views1 page

    Postsea Common Application PDF

    Uploaded by

    Ashirwad Behura
    This document is an application form for training courses offered on the Training Ship Rahaman. It requests personal details of applicants such as name, nationality, date of birth, certification numbers, and shipping company. The applicant must declare that any valuables brought are at their own risk and absolve the training ship of liability. The applicant also agrees to indemnify the training ship from injury claims and consents to emergency medical treatment, paying associated costs. Contact information of a next of kin is also requested. The bottom section is for office use only, to record fees paid and certificate/residential status.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    REV. NO.

    00
    REV. DATE: 01-06-2017 TSR:ALL:APLC: :01
    TRAINING SHIP RAHAMAN
    APPLICATION FORM

    SR.NO. COURSE NAME COURSE DATE BATCH NO:

    PERSONAL DETAILS

    NAME OF APPLICANT:___________________________________________________________________________

    NATIONALITY : ______________________ DATE OF BIRTH _________________________

    CDC. NO: _____________________ PASSPORT NO.: _________________________

    INDoS No.: _____________________ ENROLLMENT NO: _________________________

    CERT. OF COMPETENCY:_____________ C.O.C. NO.: _________________________

    SHIPPING COMPANY: ___________________________________________________________________________

    DECLARATION:
    I HERE BY DECLARE THAT TO THE BEST OF KNOWLEDGE AND BELIEF, THE INFORMATION GIVEN ABOVE IS TRUE ANY VALUABLES BROUGHT BY ME TO
    TSR ARE AT MY OWN RISK AND I SHALL NOT HOLD TSR's OR TSR MANAGEMENT RESPONSIBLE FOR THEIR THEFT OR LOSS.

    UNDERTAKING:
    I HEREBY INDEMNIFY THE T S RAHAMAN ITS MANAGEMENT AND ITS OFFICERS FROM ANY CLAIM WHATSOEVER ARISING FROM PERSONAL INJURY,
    DEATH, SICKNESS OR ANY OTHER HARM SUFFERED BY ME AS A RESULT OF MY UNDERGOING THE SAID COURSE. I CONSENT TO ANY EMERGENCY
    MEDICAL TREATMENT WHICH MIGHT BE NECESSARY, AND TO PAY ALL CHARGES CONNECTED THEREWITH TO THE FOUNDATION AND IN THE EVENT
    OF MY SUSTAINING ANY INJURY OR ILLNESS DURING THE PERIOD OF MY TRAINING AT, 'T.S RAHAMAN' WHICH MAY WARRANT HOSPITALISATION,
    I OR MY NEXT OF KIN / RELATIVE WHOSE NAME AND ADDRESS IS MENTIONED BELOW SHALL BEAR IN FULL, ALL THE EXPENSES INCURRED FOR MY
    HOSPITALISATION BEFORE MY DISCHARGE FROM THE HOSPITAL, AND ABSOLVE SIR MOHAMED YUSUF SEAMEN WELFARE FOUNDATION FROM
    ANY FINANCIAL OR OTHER RESPONSIBILITY. WHATSOEVER FOR THE SAID TREATMENT.

    NAME, ADDRESS & TELEPHONE NO. NEXT OF KIN / RELATIVE:

    NAME:__________________________________________________ TELEPHONE NO. __________________________

    RELATIONSHIP WITH APPLICANT ____________________________________________________________________

    ADDRESS: ______________________________________________________________________________________

    E-MAIL ID: _______________________________________________________________________________________

    * I HAVE READ TERMS & CONDITIONS, CANCELLATION POLICY AND COURSE REQUIREMENTS ON T.S. RAHAMAN WEBSITE.

    SIGNATURE OF CANDIDATE:_____________________________DATE:______________________________________

    FOR OFFICE USE ONLY

    FEES RECEIVED : YES / NO RECEIPT NO________________________DATE_____________ PAID AT___________

    RESIDENTIAL / NON RESIDENTIAL : ____________________________CERTIFICATE NO:____________________

    SIGNATURE OF BOOKING CLERK:_______________________________

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