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D 2.

14

MLC Allotment Form

Personal details :
Fullname Kasmadi
Date of birth 12 Oktober 1988
Rank Safety Officer
Nationality INDONESIAN
Address xBonelemo RT.RW.001/001,
Bajo Barat
City, Country INDONESIA, LUWU
SEULAWESI SELATAN
Start date contract 1 August 2022
Contrqact type Voyage Agreement
Period contract 6 months
Wage number 5277

Monthly earnings ;
Basic wage 6.500,00 USD
FOT 357,00 USD
Leave pay 157,00 USD
Sub. Allowance on leave X
Comm. / IMO 30,00 USD
Xmas bonus 6,00 USD
Other bonus 328,00 USD
Total wage 7.826,00 USD

The above seafarer has requested that his home allotment is distributed as follow :
Account
Allotee Name Bank/Branch BIC / Iban Amount
Number
Dinik Agustiani BCA 3560777280 7.500,00 USD

Remark :
1) Letter of Assignment as provided for crew supplied through crewing agency ‘BOMOS’ is
considered to be sufficient. D 2.14 is not required for them.
2) It is obliged to have the signed ‘Allotment Form’ and ‘Employment Contract’ with you on
board and be able to present the documents upon request by any authority.

Signed for approval

Seafarer : Employer :

Name : KASMADI KADANG


Date :
Date : 04 July 2022

Version 2018-10

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