Insert title here

Fill the Seafarer's Details

New Seafarer Registration form

Full Name*

C.D.C. No.*

INDOS NO

Registration No.

Father's Name*

Identification Or Other Distinguishing Marks*

Date Of Birth*

Religion*

Marital Status*

Permanent Address*

Seafarer's Email*

Mobile Number*

* I declare that I have not previously been a member of Seamen's Provident Fund and I hereby nominate the person (s) mentioned below to receive the amount standing to my credit in the Fund in the event of my death before that amount has become payable or having become payable has not been paid and direct that the said amount shell be distributed among the said person (s) in the manner shown below against his/her/their name(s)

Enter Nominee Details (Atleast one is mandatory)*

Nominee #1

Nominee Full Name:

Nominee Full Address:

Nominee's Relationship:

Share Payable(%):

Email:

Whether Minor or Major:

Age of Minor:

Guardian Full Name:

Guardian Full Address:

Yes No *Certified that I have no family as defined in paragraph 2(e) of the Seamen's Provident fund Scheme, 1966 and should I acquire a family hereafter, the above nomination should be deemed as cancelled

Yes No *Certified that my father/mother is dependent upon me.

* I hereby declare that the information given in this application is true and correct to the best of my knowledge and belief.