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Rohi Global Services Pvt. LTD

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ROHI GLOBAL SERVICES PVT. LTD. QUALITY SYSTEM MANUAL.

TITLE: QMS MANUAL ISO 9001:2015.


ISSUE NO.: 01. ISSUE DATE: 01.06.17
DOC. NO.: QSM/01
REV NO.: 00 REV DATE: 01.06.17

Annexure I: Declaration of No Fees and Other Charges

DECLARATION BY SEAFARER

I have been appointed to join __________________________ (Ship/Vessel Name) by ROHI


Global Services Pvt. Ltd as an agent & on behalf of the owners of the vessel and I wish to
make following declaration.
I have neither paid nor have I to pay in future, any money to ROHI Global Services Pvt. Ltd.
or any of its employee or agent for getting this employment, but understand that costs, if
any, for obtaining national statutory medical certificate, the national seafarer’s book and
passport (not including, however, the cost of visas) are to be borne by me. Further, no
demand of any sort with regard to the offer of engagement on a particular ship or by
particular companies has been made to me, including but not limited to the offer of joining
advances or any other financial transaction between the ship-owner and myself.
While staying in hotel on company’s account (if approved prior to joining in writing) during
travel period to and from the vessel, I will settle my own account prior leaving the hotel with
regards to expenses incurred for personal long distance telephone calls, entertainment of
guests, bar, laundry etc.
I am in possession of my original Contract of Employment and all other original certificates
and documents required for this appointment in accordance with STCW, Flag and value
added in-house courses. I am carrying such certificates and documents in original and will
hand over them to the HR Manager / Crew Purser of the vessel immediately upon my arrival
for his/her scrutiny. I am aware that if I fail to do so, vessel’s schedule may be jeopardized
and the vessel and her owners may suffer heavy losses.
I am aware that if I fail to produce required original certificates and documents, the Master
may at his discretion refuse to sign me on and send me back to my home port of
engagement at my cost & risk and company may initiate action against me.
I have been made aware of my rights and duties under the employment contract.

____________________________ _________________________ ________________


Seafarer’s Signature (Signed before me) Date
ROHI Manager’s/Director Signature

Copy: Seafarer Original: Seafarer’s file

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ROHI GLOBAL SERVICES PVT. LTD. QUALITY SYSTEM MANUAL.

TITLE: QMS MANUAL ISO 9001:2015.


ISSUE NO.: 01. ISSUE DATE: 01.06.17
DOC. NO.: QSM/01
REV NO.: 00 REV DATE: 01.06.17

MS/ MV:
Name : Rank: ECN:
Details of Nominee to receive compensation in case of fatality:
Last Name * First Name * Middle Name Relationship * Gender *

Date of Birth * Place of Birth Nationality * Tel.: (+country code, area code, Mob No.: (+country code –
Tel No.) No.)

Address if different from seafarers address * :

City *: State *: Post Code *: Country *:

Family Data
Date of Birth Date Place Valid
Relation* Gen* First Name * Last Name * Passport No.
* Issued Issued until
Spouse M/F

Child M/F

Child M/F

Child M/F

Child M/F
Address of spouse if different from seafarers address* :

City *: State *: Post Code *: Country *:

Tel.: (+country code, area code, Mob No.: (+country code cell
Tel No.) No.) E-Mail: Alt contact No.

Bank Data of NOK where compensation will be wire transferred


Name of Bank *:

Branch *:

Bank Account Number*:

Bank Swift Code *: Bank IFSC Code *:

Name (As appears in Bank account) *:


Bank Address *:

City*: Post Code*:


* Mandatory data

____________________ ________________ ____________________


Seafarer’s Signature Date Witnessed by

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