Physical Declaration
    Medical Inspection Date Issued Date of Expiry Country of Issue
    Malaysia
    Other
    Vaccination Date Vaccination Date of Expiry Country of Issue
    Yellow Fever
    Cholera
    Other
    Covid-19 Vaccination Vaccination Type Date Vaccination Country of Issue
    1st Dose
    2nd Dose

    HAVE YOU EVER SIGNED OFF DUE TO MEDICAL REASON?

    HAVE YOU EVER SUFFERED OR ARE SUFFERING FROM ANY AILMENT OR DISEASE THAT IS LIKELY TO RENDER YOU UNFIT FOR SEA SERVICE OR LIKELY TO ENDANGER THE HEALTH/WELL BEING OF OTHERS?

    DO YOU HAVE ANY BODILY DEFECTS OR DEFICIENSIES?

    ARE YOU ADDICTED TO ALCOHOL OR DRUGS OF ANY KIND?

    ARE YOU A MEMBER OF ANY RELIGIOUS OR POLITICAL GROUP?

    HAVE YOU EVER DEPORTED, DENIED VISA OR BANNED FROM ENTERING ANY COUNTRY?

    HAVE YOU EVER BEEN CONVICTED OF A CRIMINAL OR DRUG OFFENCE OR HAVE ANY PENDING OFFENCES?

    DO YOU HAVE ANY OBLIGATIONS TOWARDS YOUR CURRENT/ PREVIOUS EMPLOYERS?

    Medical History

    [multistep multistep-735 "https://southpointgroup.com/form-page-3/"]