Merchant Navy Medal: Nomination Form

MERCHANT NAVY MEDAL FOR MERITORIOUS SERVICE NOMINATION FORM

Please read the accompanying guidance notes before completing this form.

NOMINEE Please clearly print or type the following details about the person you are nominating. You must ensure that all sections of this form are completed or we will be unable to consider your nominee.

I nominate the following person for the Merchant Navy Medal for Meritorious Service: It is most important that the name given is accurate Surname: and that the spelling is correct.

Forenames:

Known as: If different from above.

E.g. Mr, Mrs, Miss, Title: Captain etc.

Post (If applicable) nominals:

Please include as full an Address: address as possible. Post Code:

Or approximate age if date Date of Birth: of birth is not known.

Telephone If known. (Incl. area code if no: land line number.)

Email If known address

Please state nominee’s length of service in the Length of Merchant Navy/Fishing service: Fleets of the UK, Isle of Man or Channel Islands Industry (Merchant Navy, Fishing Fleet, etc) :

The information contained in this nomination is strictly confidential and will not be communicated to any person other than those involved in considering the nomination. THE RECOMMENDATION

Please tell us how your nominee has rendered meritorious service in the Merchant Navy and/or Fishing Fleets of the United Kingdom, the Isle of Man or the Channel Isles. We are looking for persons who have shown devotion to duty and exemplary service which has been of particular value and has constituted an outstanding example to others. It is important that you give as much detail as possible about what your nominee has achieved which makes him/her stand out against others and make it clear if the achievement is in one area or in a number of different areas. POSITIONS HELD

Please list positions held by the nominee, with approximate starting and finishing dates, in order that we may verify the nominee’s length of service.

LETTERS OF SUPPORT Normally, each nomination should be supported by letters from two or more other persons who are familiar with the nominee and his or her achievements. The letters should preferably be attached to this form, but they may be sent separately. Please list below the names of the supporters and tick the box if their letter is to follow.

Supporter’s name Role in which the Dates of knowledge (if Please tick the supporter has known known) box if their letter the nominee (for of support is to example, colleague, follow. friend). DETAILS OF PERSON MAKING THE NOMINATION

My name and address:

(Incl. title e.g. Mr, Mrs, Miss, Surname: Captain etc)

Forenames:

This address will be used for Address: an acknowledgement and any future correspondence.

Post Code:

Telephone (Incl. area code if land line no: number.)

Email address:

Please state your Relationship to relationship to the nominee nominee: (e.g. colleague, friend, family member).

How did you hear about the Merchant Navy Medal

By submitting this nomination you declare that the information you have provided is – to the best of your knowledge – accurate and complete. Providing false information may lead to your nominee being removed from consideration for an award of the Merchant Navy Medal for Meritorious Service.

Signature Date

Please send this form and any enclosures to:

Maritime Training Department for Transport Telephone no: 07775 026882 Zone 2/33 Or 07795 883524 Great Minster House 33 Horseferry Road Email: [email protected] LONDON SW1P 4DR