MFCI Form/Disembarkation

Rev. 04 / 08-May-2014

MAERSK - FILIPINAS CREWING, INC.

DISEMBARKATION FORM
Date Reported: APM ID:

RANK: NAME:
ADDRESS (Permanent) City/Municipality:
Telephone No.: Cell Phone No: Next-of-Kin:
Marital Status: Gender: E MAIL:
LAST VESSEL SIGN OFF DATE
VESSEL FLAG TYPE OF VESSEL
Months on board Finished contract?

Date of PEME Certificates and

TRAVEL AND VISA DOCUMENTS REMARKS
Expiration Vaccinations
Seaman's Book Medical
Passport Yellow Fever
US Visa C1/D Cholera
US Visa B1/OCS Hepa A
Schengen Visa Diphtheria
Australian MCV Others: ___________________
Others: ___________________
FLAG STATE
PHILIPPINE ISSUED CERTIFICATES ENDORSEMENT
Certificate of Competency (COC) MPA UK
Certificate of Endorsement (COE) DUTCH LUX
General Operator's Certificate (GOC) FRENCH HKG
DNV Certificate DFSE

Interview
(To be filled out by Seafarer) (To be filled out by Crew Ope
Note: Please answer below questions with Yes or No Remarks:
1. Have you been sent for medical checkup/treatment abroad? ____________
If yes, how many visits to the Doctor you had on board? ____________________
2. Do you agree with the overall appraisal evaluation given on board? _____________
3. Did you encounter any problems in relation to other seafarers on board? ______________
4. Do you have a good relationship with your co-workers? __________
5. Are you satisfied with the quality of food served on board? _____________
6. Do you like to work with other nationalities? ____________
7. Are you being provided with a good quality of Personal Protective Equipment (PPE)? __________
8. Is 10hr rest day in a day / 77hr a week is being implemented? ___________
9. Are you satisfied with the performance of MFCI towards your needs? ____________
10. Are you willing to return to the vessel? ___________

Seaman's Signature: ________________________________ Crew Operator's Signature: _____________

Voluntary Submission of Documents
To Whom It May Concern:
I, do hereby voluntarily submit my original documents to my Crew Operator.
I understand that these documents are required for the arrangement of my next deployment with Maersk-Filipinas Crewin

Agreed reporting date for Embarkation processing: ______________

Availability date to join vessel: Seaman's Signature: ______________________________
MFCI Form/Disembarkation
Rev. 04 / 08-May-2014

NEXT ASSIGNMENT
REQUIRED COURSES: RANK:
Vessel:
License No.:
DOH COMPRE
REMARKS: Medical
Hepa A
Diphtheria
Cholera
Seniority Year : Typhoid
Superior Cert (Yes/No): Others:
Passport No. (for SM Lazo): ____________________
US VISA requ
Cleared for Processing (UID): _______________ With higher License/COC (Y/N)
If Yes, expiration date
 MFCI Form/Disembarkation
Rev. 04 / 08-May-2014

RSK - FILIPINAS CREWING, INC. Appraisal Score

MBARKATION FORM

Province:
Mobile No. of NOK
E MAIL:

Date of Expiration REMARKS

Others: ___________________

Date of Expiration REMARKS

Interview
(To be filled out by Crew Operator)

Crew Operator's Signature: _____________________________

untary Submission of Documents

arrangement of my next deployment with Maersk-Filipinas Crewing, Inc.

Seaman's Signature: ________________________________

MFCI Form/Disembarkation
Rev. 04 / 08-May-2014

NEXT ASSIGNMENT
Embarkation Date: _________
Duration of Contract: _______
Flag: ______________

Passport No. (for SM Lazo): _______________________________