Marine Surveyor Medical Fitness Declaration Form
Personal Details
Full Name
Date of Birth
Identification/Passport No.
Nationality
Contact Number
Email Address
Medical History
I hereby declare I am fit for marine surveying duties.
Please indicate if you have ever had any of the following medical conditions:
Heart condition
Epilepsy/Seizures
Diabetes
High blood pressure
Respiratory problems
Mental health issues
Vision impairment
Other (please specify below)
If "Other" or any of the above checked, provide details:
Declaration
I hereby confirm that the information provided above is accurate and complete to the best of my knowledge. I understand that withholding or providing false information may affect my eligibility to perform marine surveyor responsibilities.
Signature
Date