Onshore Complaint Form

MLC ON -SHORE COMPLAINTS REPORTING (MLC Regulation 5.2.2)

All vessels must have an onboard procedure for seafarers but it is recognized that it may not always be appropriate for a seafarer to use the onboard complaint system or the complaint may not be able to be resolved at the shipboard level. However, in the event it is unable to be resolved onboard, seafarers may make ON-SHORE COMPLAINTS REPORT to Myanmar Port State Control who will investigate the complaint.
Confidential document if details of the seafarer are included (standard A.5.2.2, paragraph 7)
Date/time, local time of receipt:*
Name of the complainant*

PrefixFirst NameLast Name
Phone*

Area CodePhone Number
E-mail*
Address of the complainant*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Relation to the ship*
Confidentiality necessary*

YesNo
Ship’s particulars
Ship’s name*
IMO-number*
Flag*
Next port of call
Ratifying state

YesNo
Shipowner’s name

First NameLast Name
IMO company number (Please check at DOC)
Shipowner’s address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Details regarding the complaint
Is the complaint regarding general working or living Single Seafarer General conditions onboard conditions on board a vessel or a single seafarer?
Are you directly affected by the complaint?

YesNo
Have the onboard complaint procedures been used to try and resolve this complaint?

YesNo
If the onboard complaint procedures were not used, please explain why.
Details of the complaint*
Relevant Article, Regulation or Standard
Attached file
A/

Browse Files

Cancelof
B/

Browse Files

Cancelof
C/

Browse Files

Cancelof
Action Taken
will be used by Authority
Follow-up action
will be used by Authority
Should be Empty:

MLC ON -SHORE COMPLAINTS REPORTING (MLC Regulation 5.2.2)