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Beneficiary Form

The document is a beneficiary/next of kin form for an employee of OSM Crew Management. It collects personal information about the employee such as name, nationality, date of birth, and contact details. It also collects details about designated beneficiaries for pension and insurance benefits, the employee's next of kin, and any dependent children. The employee signs the form to confirm the provided information.

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Calmcoin “Istan”
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43 views

Beneficiary Form

The document is a beneficiary/next of kin form for an employee of OSM Crew Management. It collects personal information about the employee such as name, nationality, date of birth, and contact details. It also collects details about designated beneficiaries for pension and insurance benefits, the employee's next of kin, and any dependent children. The employee signs the form to confirm the provided information.

Uploaded by

Calmcoin “Istan”
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Approved by: Managing Director

OSM Crew Management


Effectivity Date: 03 Aug 2021
Document Title: Beneficiary / Next of Kin Form Revision No.: 01
Document ID: CRW - 29 Pages: 1 of 1  Global  Local

EMPLOYEE DATA RECORD


Employee No. Nationality: Date of Birth: Marital Status:
Name: (Last, First, Middle)
Place of Birth:
Mailing Address:
Email Address: Contact Numbers:

BENEFIT FOR IMMEDIATE FAMILY MEMBERS ONLY:


Designated Beneficiaries:
(Person(s) who will benefit from the Pension Fund plan and Insurance Cover (as per
CBA Conditions in case of loss of life)
Date of Birth:
Address:
Contact Numbers:

NEXT OF KIN DETAILS:


Next of Kin:
(Designated person to be contacted for Seafarer’s matters)
Relation with the Seafarer:
Date of Birth:
Address:
Contact Numbers:

( ) NUMBER OF DEPENDENT CHILDREN


1. Name: Date of Birth:
Age: Sex:
2. Name: Date of Birth:
Age: Sex:
3. Name: Date of Birth:
Age: Sex:
4. Name: Date of Birth:
Age: Sex:

__________________________________
SIGNATURE OVER PRINTED NAME OF INSURED

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