MASA Seafarers’ Fund Online Registration Form

SEAFARER INFORMATION

Seafarer Name *

Full name

New I/C Number

Mandotary for local and government
(e.g. 700614145345)

Old I/C / Army / Police No.

(e.g. A4744161)

Passport No.

Mandatory for foreigner

Nationality *

Date of Birth *

Place of Birth *

Gender *

Race * Race

Religion * Religion

Address *

City *

Postal Code *

State * State

Country *

House Telephone Number *

Office Telephone Number

Email Address

SERVICE INFORMATION

Seafarer Type *

Service At Department

Mandatory for government seafarer

Department On Board Ship Department On Board Ship

Current Rank *

Distinguish Marks

HEALTH INFORMATION

Certificate Number *

Medical Practioner Number * Medical Practioner Number

Medical Status *

Medical Checkup Date *

Certificate Expiry Date *

Limitation

If any

Supported Documents *

Maximum upload size: 67.11MB

Latest Photo, Certificate of Compentency(COC), Certificate of Recognition(COR)
(please compile your file as ZIP File)

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