Seafarers’ Emergency Fund Eligibility Form

Have you read the guidance about how to apply to the fund?*

Yes

No

Guidance Notes:

As you have answered ‘No’, please follow this link to the online guidance documentation, then come back to this form once read.

If you are not sure whether the person fits any of the criteria or you do not understand any of these questions, please contact [email protected].

Are you a recognised and legitimate seafarers’ welfare organisations providing direct services to seafarers?*

Yes

No

We are only able to accept applications from recognised and legitimate seafarers’ welfare organisations

Has the applicant been employed as a seafarer within the last 12 months?*

Yes

No

You can only apply on behalf of a person who has been employed as a seafarer within the last 12 months.

Is the financial support for the seafarer themselves or their spouse/partner or children?*

Yes

No

You can only apply on behalf of a seafarer, their spouse/partner or children.

Does the seafarer understand that the fund cannot provide financial support for long-term or ongoing health issues/permanent disability/palliative care/health issues with limited chance of recovery?*

Yes

No

The fund cannot be used for long-term or ongoing health issues / permanent disability / palliative care / health issues with limited chance of recovery.

Is the financial support for something that is happening currently?*

Yes

No

The fund cannot be used for a problem that is no longer current.

Has the seafarer confirmed that they have not received any financial support from the fund within the last 12 months?*

Yes

No

Our initial assessment shows that you are not eligible to apply to the Seafarers’ Emergency Fund. If you have any queries, please contact [email protected]. If you are a seafarer or family member of a seafarer, you can contact ISWAN’s free, confidential, 24-hour helpline SeafarerHelp for further guidance or support – all contact details are available at www.www.iswan.org.uk/get-support/seafarers/.

Section 1: Applying organisation

Is your organisation a member of ISWAN?*

Yes

No

Don't now

Organisation Name*

Street

City

Postcode

Country*

Section 2: Applying organisation contact details

Contact First Name*

Contact Last Name*

Contact Email*

Contact Phone

Start the number with a plus sign and the country code, e.g. +44 for UK

Contact Position

Please ensure you have your organisation's authority to make this application.

Section 3: Applying on behalf of

Notes:

• You must confirm that the person(s) involved is (are) working seafarer(s) or the immediate family member(s) of a working seafarer; please give full details below

Given Name*

Family Name*

Is a seafarer*

Yes

No

Rank*

If not a seafarer: Relationship to seafarer*

Date of Birth*

Nationality*

Section 4: A short explanation of the situation

Notes:

• If a ship is involved please provide its IMO number, full name, the Country in which it is registered, and the type of vessel.

• Provide a short explanation of the situation/need including how and when it came about.

• The explanation of the situation should be no more than 3,000 characters (approximately 500 words).

Explanation of the situation*

Is there a ship involved?*

Yes

No

Ship Details:

IMO Number*

Ship Name*

Country of Registration*

Type of Vessel*

Section 5: A short explanation of how the need can be met

Notes:

• Explain how the need can be met, i.e. by counselling, medical procedure, or the purchase of transportation, etc.

• This explanation should be no more than 3,000 characters (approximately 500 words).

How the need can be met*

Section 6: The full monetary cost of meeting the need

Notes:

• A short explanation of the full cost of meeting the need broken down into appropriate headings.

• This explanation should be no more than 3,000 characters (approximately 500 words).

Total cost of meeting the need (USD)*

Total Cost Explanation*

If the full cost of meeting the need exceeds this grant, explain where the remainder will come from.

Where will the remainder come from?

Section 7: List the legally responsible, and others, you have contacted to meet this need

Notes:

• By legally responsible, we mean flag state, port state, owner, crewing agency, etc.

• See the ‘STATEMENT’ on page 8.

Organisations Contacted:

Type

e.g. flag state, port state, crewing agency, etc.

Name

Section 9: Statement

By checking 'Confirmed' below, I confirm that:

i) I am reasonably certain that alternative funding is not readily available locally or from other legally responsible parties such as the ship owners, employment agencies, flag states or similar resources.

ii) This application is for a seafarer(s) or an immediate member of their family.

iii) I have read and understood both the “How to apply” and the “Terms and Conditions” documents that are on the ISWAN website at www.seafarerswelfare.org

Requested Grant Details:

Amount Requested (in USD)*

Currency grant to be paid in*

Section 8: The amount of Seafarer Emergency Fund grant requested and how it is to be used

Notes:

• No administration fees or any other form of payment may be taken by the applying organisation, or any other organisation, involved in the receipt of a SEF grant.

• No monies from the SEF grant can be given directly to a seafarer or member of their family. The Applying Organisation must provide/purchase the goods/services that will benefit the seafarer.

• Please state the grant requested in US Dollars. When it comes to payment grants can be paid quickest in GB Pounds followed by US Dollars. If you want the grant paid in a different currency state which. We will try to meet this request but it is not always possible and it will take longer.

Confirm*

Confirm

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Seafarers’ Emergency Fund Eligibility Form