Merchant Navy Fitness For Sea Service
Personal Details
Full Name
Date of Birth
Nationality
Rank/Position
Seaman Book Number
Ship Name / IMO Number
Medical Examination
Height (cm)
Weight (kg)
BMI
Blood Pressure
Vision (Right/Left)
Hearing
Medical Remarks
Doctor's Declaration
Date of Examination
Location
I hereby declare that the above-named seafarer is:
FIT for Sea Service
UNFIT for Sea Service
Doctor's Name
License/Registration No.
Signature