Sheet1

	D	E	F	G	J	K	L
1
2		*Personnel Registration Form*
3
4
5	Your Details	Please use BLOCK capitals.			Fields marked * must be completed.
6
7	Surname *				Forename(s) *
8
9	Date of Birth *	/ / (Day/Month/Year)			Known As/Nickname
10
11	Title (e.g. Mr/Mrs) *				National Ins No (UK*)	UK ONLY
12
13	Marital Status *				Passport Number *
14
15	Sex (delete as reqd) *		MALE / FEMALE		Passport Expiry Date	/ / (Day/Month/Year)
16
17	Nationality *				Place of Birth
18
19	Your Contact Details
20	Home Address *				Home Telephone *
21
22					Daytime/Office Phone *
23
24					Mobile/Cell Phone
25
26	Country *				Email Address
27
28	Postal/Zip Code *
29
30
31	Emergency Contact Details
32	Surname *				Forenames *
33
34	Title (e.g.Mr/Mrs) *				Relationship *
35
36	Home Address *				Daytime Phone *
37
38					Night Phone *
39
40	Country *				Mobile/Cell Phone
41
42	Postal/Zip Code *				Is this your Next of Kin ? *		YES / NO
43	You can add further Emergency Contacts by completing this section on the next page. If you do add further
44	emergency contacts, please indicate their priority of contact:				Contact Priority		1
45
46
47	Employment Details
48	Company Name *				Job Title *
49
50	Address *				Telephone Number *
51
52					Fax Number
53
54					24hr Emergency Response Telephone Number
55					24hr Emergency Response Telephone Number
56	Country *
57
58	Postal/Zip Code *				Liability Insurance Expiry Date		UK ONLY
59
60	Who in your company should we contact if further information is required ?
61	Name				Day Phone
62
63	Department				Email Address
64
65
66
67	Your Certification Details
68				Fields marked * must be completed.
69
70	Expiry date medical *	/ / (Day/Month/Year)
71
72	Expiry date survival *	/ / (Day/Month/Year)			Name training centre
73
74	Expiry date VCA	/ / (Day/Month/Year)			Name training centre
75
76
77	Data Protection Act	Organisations completing this form on behalf of individuals, must inform the individual of the following:
78	Ð	The details you supply above will be recorded in the Vantage Personnel On Board (POB) system. The controllers of the VantagePOB system Leading Oil & Gas Industry Competitiveness (LOGIC) are registered with the Information Commissioner for the relevant uses of your personal information. Formal agreements are also in place between LOGIC and the companies that use VantagePOB, supporting this use under the terms of the Dutch Data Protection Act 'Wet Bescherming Persoonsgegevens'. Under the terms of the act, you have the right to obtain a copy of the information held about you, upon payment of the appropriate fee.
79
82
83
84
85	Emergency Contact Details priority 2
86	Surname *				Forenames *
87
88	Title (e.g.Mr/Mrs) *				Relationship *
89
90	Home Address *				Daytime Phone *
91
92					Night Phone *
93
94	Country *				Mobile/Cell Phone
95
96	Postal/Zip Code *				Is this your Next of Kin ? *		YES / NO
97
98					Contact Priority		2
99
100
101	Emergency Contact Details priority 3			Wintershall passenger: please fill out our general practition (huisarts)
102	Surname *				Forenames *
103
104	Title (e.g.Mr/Mrs) *				Relationship *	General Practition
105
106	Home Address *				Daytime Phone *
107
108					Night Phone *
109
110	Country *				Mobile/Cell Phone
111
112	Postal/Zip Code *				Is this your Next of Kin ? *		YES / NO
113
114					Contact Priority		3

Sheet1 A B C D E F G H I J K L M 1

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