Enrollment Form Fees – Suezmax Marine Services

Enrollment Form

Full Name*

Mobile Phone*

Email Address*

Date of Birth*

Father's Name*

Emergency Contact Number

Street Address*

Apartment, house no., etc

City*

State/Province*

ZIP / Postal Code*

Country*

Medically Fit Yes
No

Any Visual Aids Yes
No

Color Blindness Yes
No

Can you swim? Yes
No

Yes, I hereby declare that all the statements furnished in this application are true and correct to the best of my knowledge and belief. I understand that my admission will be cancelled if any information submitted to me is found incorrect. Further, I confirm that I have read and understood the contents of the prospectus and website and agree to all the terms and conditions contained therein.

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Enrollment Form

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