Complete the following. Each Employee shall have at least 10 (ten) hours … … … in … … … hours • He shall work 77 (seventy-seven) hours … … … • The 10 (ten) hours of rest may be broken into no more than two periods, one of which … … … • The interval between consecutive periods of rest shall not … … … • The most frequent drills are: … … … • UMS ships are ships that … … … • IN UMS ships the whatch shall be kept so that … … … • If the normal period of rest is disturbed by call-outs, then … … … Medical Attention
Complete the following. (PLEASE PRINT) ----------------------------------------------------------------------------------------------------------------- Primary Proposed Insured _______________________________________________________________________________________ Other Proposed Insured _________________________________________________________________________________________ (APPLICABLE ONLY FOR A JOINT LIFE OR SURVIVORSHIP POLICY) Owner (if other than Primary Proposed Insured)__________________________________________________________________ Modal Premium Amount Received __________________________________________________________________________________ Date of Policy Application _____________________________________________________________________________________ -----------------------------------------------------------------------------------------------------------------
Complete the following. 1. Borrower [and Qualified Borrower] hereby request[s] (check one box only): ¨ A Borrowing; or ¨ A conversion or continuation of Loans
Complete the following. (PLEASE PRINT) -------------------------------------------------------------------------------- Primary Proposed Insured __________________________________________________ Other Proposed Insured ____________________________________________________ (applicable only for a joint life or survivorship policy) Owner (if other than Primary Proposed Insured)_____________________________ Modal Premium Amount Received _____________________________________________ --------------------------------------------------------------------------------
