MICLYN EXPRESS OFFSHORE

ALLOTMENT AUTHORISATION FORM L 3- V 2- 1 FO

ALLOTMENT AUTHORISATION FORM

SEAFARERS NAME:
RANK:
VESSEL:
PASSPORT:
BASIC WAGE (US$):
DATE FULL PAY COMMENCES:
DATE FULL ALLOTMENT
COMMENCES:
ALLOTMENT PERCENTAGE %

ALLOTMENT NO:
ALLOTEE FULL NAME:
ADDRESS:
NAME OF BANK:
ADDRESS OF BANK:
CURRENCY:
BRANCH:
ACCOUNT NUMBER:
ALLOTMENT NO:
ALLOTEE FULL NAME:
ADDRESS:
NAME OF BANK:
ADDRESS OF BANK:
CURRENCY:
BRANCH:
ACCOUNT NUMBER:

FAISAL REZZAH
AB
EXPRES 77
B2246157
20 %
80% HA 20% POB

100%

1
TATI TRESNAWATI
PERUM DRAMAGA PRATAMA BLOK R
BNI
DRAMAGA BOGOR
USD / IDR / PESOS / THB / EURO / SGD
80 %
0171272978
2

USD / IDR / PESOS / THB / EURO / SGD

** Note: No changes for Allotment is allowed until end of contract **

STATEMENT OF UNDERSTANDING

By completing/signing this form:

- I confirm that the above information is correct;
- I will inform my employer for any changes to the allotment details (amount and payee
timely manner;
- I give consent to my employer to allocate the allotment as per my advice above.
I also understand that any problems once the allotment is delivered to the receiver (pay
beyond the control of the company. The company is only responsible for ensuring
proper/prompt delivery of the allotment as per the instruction received from me.
MANDATORY: MINIMUM 80% OF MONTHLY EARNINGS TO BE SENDTHRU HOME ALLOTMENT
FAISAL REZZAH

SEAFARERS SIGNATURE
DATE: 20-10-2015

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