Seafarers' Emergency Fund Application

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SEAFARERS’ EMERGENCY FUND APPLICATION


Before completing this application form please read the “How to apply” and “Grant terms” documents
which are on the ISWAN website at www.seafarerswelfare.org under the “Relief Funds” tab. Please
also read our Data Protection Policy which is on the above website.

1 APPLYING ORGANISATION
Organisation Name:
Address:
Country:
Contact person:
Email:
Telephone number:

2 APPLYING ON BEHALF OF
Given name Family name Rank Date of Nationality
Birth

3 A SHORT EXPLANATION OF THE SITUATION


Notes:
i) Provide a short explanation of the situation/need including how and when it came about.
ii) You must confirm that the person(s) involved is (are) working seafarer(s) or the immediate family
member(s) of a working seafarer. In which case explain the relationship and give full details of the
seafarer in the section (2) above.
iii) If a ship is involved please provide its IMO number, full name, the Country in which it is
registered, and the type of vessel.
iv) The explanation of the situation should be no more than one page of A4.

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4 A SHORT EXPLANATION OF HOW THE NEED CAN BE MET


Notes:
i) Explain how the need can be met i.e. by counselling, medical procedure, or the purchase of
transportation etc.
ii) This explanation should be no more than one page.

5 THE FULL MONETARY COST OF MEETING THE NEED


Notes:
i) A short explanation of the full cost of meeting the need broken down into appropriate headings.
ii) This explanation should be no more than one page of A4.

6 LIST THE LEGALLY RESPONSIBLE, AND OTHERS, YOU HAVE CONTACTED TO MEET THIS NEED
Note:
i) By legally responsible we mean Flag state, Port state, Owner, Crewing agency etc.
ii) See the “STATEMENT” below, item 8 i).
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7 THE AMOUNT OF SEAFARER EMERGENCY FUND GRANT REQUESTED AND HOW IT IS TO BE USED
Notes:
i) No administration fees or any other form of payment may be taken by the applying organization,
or any other organization, involved in the receipt of a SEF grant.
ii) No monies from the SEF grant can be given directly to a seafarer or member of their family. The
Applying Organization must provide/purchase the goods/services that will benefit the seafarer.
iii) Please state the grant requested in US Dollars. When it comes to payment grants can be paid
quickest in GB Pounds followed by US Dollars. If you want the grant paid in a different currency state
which. We will try to meet this request but it is not always possible and it will take longer.
Amount requested: Currency grant to be paid in:

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8 STATEMENT: I confirm that:


i) I am reasonably certain that alternative funding is not readily available locally or from other legally
responsible parties such as the ship owners, employment agencies, flag states or similar resources.
ii) This application is for a seafarer(s) or an immediate member of their family.
iii) I have read and understood both the “How to apply” and the “Terms and Conditions” documents
that are on the ISWAN website at www.seafarerswelfare.org
Print Name: Date:
Position:

05/04/2018

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