Field marked with asterisk
*
is mandatory to fill in
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Application Type
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Discharge Book
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Seafarer Information
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Seafarer Type *
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Seafarer Name
*
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New I/C Number
*
(mandotary for local and government)
(e.g. 770814145495)
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Old I/C/Army/Police No.
(e.g. A3766181)
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Passport No.
*
(mandatory for foreigner)
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State of Birth
*
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Service At Department
*
(mandatory for government seafarer)
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Nationality
*
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Address
*
(only first line is mandotary to fill)
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Postcode
*
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City
*
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State
*
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(fill-in this field if state is others)
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Country
*
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(fill-in this field if country is others)
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House Tel. No.
(e.g. 0342577828)
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Office Tel. No.
(e.g. 0342577828)
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Gender
*
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Race
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Religion
*
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Distinguish Marks
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Department
*
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Current Rank
*
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Place of Birth
*
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Date of Birth
*
(format as dd/mm/yyyy)
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Email
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Eye Color
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Hair Color
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Height
(input in cm unit)
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Next of Kin Information
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Next of Kin Name
*
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New I/C No.
(e.g. 770814145495)
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Old I/C No.
(e.g. A3766181)
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Relationship
*
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Address
Copy address from above
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Postcode
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City
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State
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(fill-in this field if state is others)
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Country
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(fill-in this field if country is others)
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House Tel. No.
(e.g. 0342577828)
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Office Tel. No.
(e.g. 0342577828)
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Health Information
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Certificate No.
*
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Medical Practioner No.
*
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Medical Status
*
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Medical Checkup Date
*
(format as dd/mm/yyyy)
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Certificate Expiry Date
*
(format as dd/mm/yyyy)
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Limitation (if any)
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Supported Documents
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Latest Photo
(max. 50 KBytes)
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[Remove]
(No file),
0 byte
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New I/C (frontpage only) / Passport
(new i/c for local and government, passport for foreigner)
(max. 250 KBytes)
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[Remove]
(No file),
0 byte
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Certificate
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