Application Form For Seafarers In Transit - Under The Danish Transfer System (Visa Exemption For Seafarers)

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APPLICATION FORM
For seafarers in transit - under the Danish Transfer System (visa exemption for seafarers)
FOR OFFICIAL USE:
ISSUER:
RECIPIENT:
AUTHORITY
(STAMP)
SURNAME/CODE OF OFFICIAL:
DATA ON SEAFARER:
1A
1B
SURNAME(S):
FORENAME(S):
1C
1D
NATIONALITY:
RANK/GRADE:
2A
2B
PLACE OF BIRTH:
DATE OF BIRTH/GENDER:
3A
4A
PASSPORT NUMBER:
SEAMAN'S BOOK NUMBER/ISSUING COUNTRY:
3B
4B
DATE OF ISSUE:
DATE OF ISSUE:
3C
4C
PERIOD OF VALIDITY:
PERIOD OF VALIDITY:
DATA ON VESSEL AND SHIPPING AGENT:
5A
5B
NAME OF SHIPPING AGENT:
TELEPHONE NUMBER:
6A
6C
NAME OF VESSEL:
FLAG:
IMO NUMBER:
6B
7A
7B
DATE OF ARRIVAL:
ORIGIN OF VESSEL:
8A
8B
DATE OF DEPARTURE:
DESTINATION OF VESSEL:
DATA ON MOVEMENT OF SEAFARER:
9
FINAL DESTINATION OF SEAFARER:
REASONS FOR APPLICATION:
SIGNING ON
TRANSFER
LEAVING SERVICE
10
MEANS OF TRANSPORT
11
CAR
TRAIN
AEROPLANE
DATE OF:
12
ARRIVAL:
TRANSIT:
DEPARTURE:
CAR*
TRAIN*
REGISTRATION No.:
JOURNEY ROUTE:
FLIGHT INFORMATION:
DATE:
TIME:
FLIGHT NUMBER:
13
Formal declaration signed by the shipping agent or the ship owner confirming his responsibility –
including economic coverage of any cost – for the stay and travel in Denmark and, if necessary, for
repatriation costs of the seafarer. Further more the shipping agent or the ship owner confirm to be aware
that visa exemption only applies to Denmark and direct exit from the Schengen area through Denmark.
* = to be completed only if data are available

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