OSM Maritime Services, Inc.
Privacy Consent Form
I, ________________________, do hereby acknowledge that I have read, understood, and agreed to MSI’s Data
Privacy Notice (the “Notice”), and do hereby voluntarily give my consent to the collection, use, disclosure, sharing,
retention, and processing of my personal information under such terms and conditions set out in the Notice.
I also acknowledge and warrant that I have acquired the consent from all parties relevant to this consent and hold
free and harmless and indemnify MSI from any complaint, suit, claim, or damage which any party may file in
relation to my consent.
Furthermore, I understand that the consent I am giving through this form shall remain in full force and effect until
I revoke it in writing.
Signed this _____ day of __________, 20___ at _____________________.
Signature: ________________________
Name: ________________________
IF INDIVIDUAL IS A MINOR OR INCAPABLE TO GIVE CONSENT
________________________________ _______________ ________
Legal Representative Relationship to Applicant Date
(Signature above Printed Name) (MM/DD/Y
Reason why Individual cannot accomplish form
(Paalala: Tawagin ang pansin ng klerk o empleyado ng MSI kung hindi nakakaunawa ng Ingles)
MLA-FRM-DPA-001 Rev No: 00 , Rev Date: 01/03/2019 Page 1 of 1
Revision Date Revision Number Approved by Details of Change
01/03/2019 00 DPO MSI First Issue
OSM Maritime Services Inc.
OSM Bldg., 479 Pedro Gil St.,
Ermita, Manila, 1000, Philippines
Debriefing Form
Name:
Rank: Vessel:
Date of Disembarkation: Reason for Disembarkation:
Date reported: Availability of crew:
Ratings: (1) Poor (2) Fair (3) Good (4) Very Good
Item Rating Comment
Overall condition of the vessel
Vessel compliance to safety /
Quality of working gear and equipment
Relationship with crew on board
Quality of provisions / food
Quality of Recreational Facilities on board
Support provided by Senior officers
Ratings: Yes / No
Other Incident and/or Issues to be reported.
(Have you submitted an OSM Crew Complaint
form?)
Any comment on the appraisal?
Would you like to return to same vessel?
Would you like to return to OSM?
Comments / Suggestions
Below field are to be field out by Crewing
Comments on Appraisal, Career Development
and Training
General Comments of Debriefing officer
Signature over Printed Name Signature over Printed Name Signature over Printed Name
Seafarer Crewing Coordinator Crewing Manager
Date: Date: Date:
Revision Date Revision Number Approved by Details of Change
12-01-2016 00 FM Offshore / FM Conventional 1st Publication
CRW-FRM-04.008 Rev.0, Rev. Date: 12-05-2016 Page 1 of 1
OSM Maritime Services, Inc.
OSM Bldg., 479 Pedro Gil St., Ermita, Manila
Tel. No.: 5238871-75 / Fax No.: 3021132
Intention to return to Work Letter
I ____________________________ Signed off ____________________________
(Seafarer’s Name) (Vessel’s Name)
declare that I intend to be available to return to work for OSM for my next contract.
The validity of this letter is for up to 120 days from the date it has been signed or until a
new employment contract is signed.
I fully understand and accept that this letter will be valid for one hundred twenty (120)
days starting from the date cited below or until the date I sign a new contract of
employment, whichever is earlier.
This document does not constitute a contract nor does it extend or amend any document
which has been previously signed by the seafarer.
Prior to joining or accepting a new assignment a seafarer must meet contractual
employment
requirements including but not limited to: clean pre-medical certificate (PEME), newly-
signed contract of employment, national & flag state documents.
_____________________________ ____________________________
Seafarer’s Signature Place / Date
Conforme:
_____________________________ ____________________________
Crewing Manager’s Signature Place / Date
MLA-CPI-FRM-003 Rev No: 01, Rev Date: 12/01/2017 Page 1 of 1
Revision Date Revision Number Approved by Details of Change
11/20/2017 01 Crewing Managers Added Crewing Manager’s signature.
Claims Manager- Crew Supersedes CRW-FRM-04.003 (Commitment to Continuous
06/15/2017 00
Management Employment with OSM Crew Management And Its Principals)
DOCUMENT CHECKLIST
Rank / Name: Vessel Name: Joining Date:
Off-Signer Crewing RTJ
Location DISPATCH
(Check if Instruction National Documents / Booklets (Crewing)
(Crew)
Valid)
Passport (______)/US Visa (______) /Schengen Visa Upper Front Pocket
(______)
Upper Front Pocket
Seaman's Book (______) with POEA E-registration
Lower Front Pocket
PDOS (______)
Lower Front Pocket
NBI
Lower Front Pocket
Yellow Fever (______)
Picture and Other Vaccines (Hepa A & B/ Cholera / Lower Front Pocket
Typhoid / etc.)
Contrac Locati RTJ DISPAT
on (Crewin CH
t g)
Docu Page
ment
Pre-Joining and Pre- 1
Page
Departure ChecklistEmployment
Seafarer’s 2
Page
Agreement
Allot / Contract 3Page
ment
Drug and Alcohol 4 Page
Declaration/D&A Policy
No 5
Page
Fee
Onboard Complaint Form 6
Page
with
Jo Procedure 7Page
bPersonal 8Page
Data 9
Off-Signer Crewing RTJ
Location DISPATCH
(Check if Instruction Medical Requirements (Crewing)
(Crew)
Valid
Local Medical (if renewal pls indicate PEME Page 10
Schedule)
Drug and Alcohol Test / Blood Test Page 11
Off-Signer Crewing RTJ
Location DISPATCH
(Check if Instruction National Certificates (Crewing)
(Crew)
Valid
Certificate of Competency (COC) (Officers only)
Certificate of Endorsement (COE) (Officers only
General Operator Certificate (Deck Officer only)
Electro-Technical Officer COP Start in
Electro-Technical Officer Endorsement Page 12
Able Seafarer Deck (II/5) or Engine (III/5) (Ratings only)
Ratings Forming Part of Navigational (II/4) or Engineering Note:
Watch (III/4) Please
Ship's Catering -NC1 or Ship's Cook-NCIII and Certificate follow
Basic Safety COP and Certificate
Proficiency in Survival Craft and Rescue Boat COP and
Certificate
DOCUMENT CHECKLIST
Proficiency in Fast Rescue Boat COP and Certificate sequence in
Advance Fire Fighting COP and Certificate inserting the
Medical First Aid COP and Certificate certificate.
Medical Care COP and Certificate
Ship Security Officer Course COP and Certificate Insert
Training
Proficiency in Ship Security Awareness with Designated
Course
Security Duties COP and Certificate
certificate
DP Certificate- Basic/Advance/Full-DP Log Book
after each
Basic Tanker Certificate (Oil/Chem/Gas) COP and COP.
Certificate
Advance Tanker Certificate (Oil/Chem/Gas) COP and
Certificate
Off-Signer Crewing Instruction RTJ
Location DISPATCH
(Check if Flag State Requirements (Crewing)
(Crew)
Valid
Flag State Medical (_______)
Flag State Endorsement/QD/CRA (_______) Insert
Flag State GOC/CRA (Deck Officers Only) (_______) required
certificates ,
Flag State Seaman's Book/CRA (_______)
as
Flag State Special Qualification Certs (SQCs- BT, PSCRB, applicable.
AFF, Gas, Chem, Oil, etc) (_______)
Off-Signer Crewing Instruction RTJ
Location DISPATCH
(Check if In House Certificates (Crewing)
(Crew)
Valid
Seminar-Orientation on OSM History, Vision, Mission and
Core Values (PEOS) /Human Relations
International Safety Management Code Familiarization (ISM) Insert
Anti-Piracy required
Marlins Test certificates
, as
CES Test
applicable.
CBT’s taken from previous vessel
Marina / Tesda Verification of Certificate
Other Documents (Refer RTJ DISPATCH
Location
Crewing Instruction (Crewing)
to Requirement Matrix) (Crew)
CBT’s to be taken prior joining Insert
required
certificates,
CBT’s to be taken while onboard as
applicable.
Other Documents (Refer RTJ DISPATCH
Location
Crewing Instruction (Crewing) (Crew)
to Requirement Matrix)
GDPR and DPA
POEA eRegistration
Appraisal/s
Insert
required
certificates
, as
applicable.
Upon Debriefing While Dispatch
CC Signature: Crew Signature:
CA Signature: CA Signature:
DOCUMENT CHECKLIST
Report Date: RTJ Date: Dispatch Date:
I hereby confirm that above list of pending documents is properly advise to me and to comply as advised.
Crew Name and Signature / Date
MLA-CRW-CHK-001 Rev No: 02 , Rev Date: 18/07/2019 Page 2 of 2
Revision Date Revision Number Approved by Details of Change
18/07/2019 02 MSI GM Standardization of Document Checklist.
09/19/2017 01 MSI GM Additional tick box for travel documents (Passport, VISA, SIRB & SRC) and
vessel acknowledgement of documents.
DOCUMENT CHECKLIST
Seafarer Information Update
Instruction: V. Next of Kin *Documentation required
For New Hires, completely fill up the items. For returning crew, use Order:
this form to correct or update your Information. Complete ONLY Relation:
the item (s) for information you wish to correct or update. Name (Last, First, Middle):
On sections stating*Documentation required, the following DOB (dd.mm.yy):
documents must be presented: Gender:
Telephone Number:
1. Certificate of Live Birth Mobile Number:
2. Marriage Certificate E-mail Address:
3. Valid Passport Street Address:
City:
I. Personal Information *Documentation required Postal/Zip Code
Employee Number: Order:
Position: Relation:
Vessel: Name (Last, First, Middle):
Name (Last, First, Middle): DOB (dd.mm.yy):
Nationality: Gender:
DOB (dd.mm.yy): Telephone Number:
Place of Birth: Mobile Number:
Marital Status: Street Address:
SSS Number: E-mail Address:
Philhealth Number: City:
TIN: Postal/Zip Code:
Pag-ibig Number : VI. Beneficiary *Documentation required
Tick if the Beneficiary details are the same as Next of Kin. If
II. Contact Information
not, indicate Name on the space provided.
E-mail 1:
Name (Last, First, Middle):
E-mail 2:
Relation:
Mobile Number 1:
DOB (dd.mm.yy):
Mobile Number 2:
Address:
Landline Number:
E-mail Address:
Street Address:
Mobile Number:
City:
Landline Number:
Municipality:
1. Child Name:
III. Other Information
DOB (dd.mm.yy):
Blood Type:
Age:
Height (cm):
Gender:
Weight (kg):
2. Child Name:
Shoe Size (cm):
DOB (dd.mm.yy):
Boiler Suit Size:
Age:
IV. Parents’ Information *Documentation required
Gender:
Father’s Name (Last, First, Middle):
3. Child Name:
DOB (dd.mm.yy):
DOB (dd.mm.yy):
Address:
Age:
Mother’s Maiden Name
Gender:
(Last, First, Middle):
DOB (dd.mm.yy):
Address:
Declaration: I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any
changes therein, immediately.
DOCUMENT CHECKLIST
Filled up by: ___________________________________ Information Verified & __________________________________
Seafarer’s Name / Signature / Date Updated in ecrew by: CC/CA Name / Signature / Date
MLA-CRW-FRM-004 REV NO: 02; REV DATE: 03/28/2019 PAGE 1 OF 1
Revision Date Revision Number Approved by Details of Change
03/28/2019 02 General Manager, MSI Merged Seafarer Contact Info Update and Beneficiary forms.
08/20/2014 01 Fleet Managers Improved form.
