Co Reg No. 2051038713 P.O.

Box 79800 Al Khobar 31952, KSA

Tel:+966 3 864 99 09 Fax:+966 3 894 1943
www.rawabiholding.com

CREW ALLOTMENT FORM

Employee Number Date Joined

NEW 9/20/2023

Crew Name
RAHMAT SETIAWAN

AS PER PASSPORT

Vessel Name Rank

RAWABI 408 CHIEF OFFICER

Personal Information of Crew

Permanent Residence Address JAMBAK JALUR 5,DISTRICT LUHAK NAN DUO,RESIDENC WEST PASAMAN,WEST SUMATERA ,INDONESIA

Date of Birth Place of Birth

16-Sep-96 JAMBAK INDONESIA

Citizenship
INDONESIAN

Account Details

Beneficiary Account Name RAHMAT SETIAWAN

Beneficiary Permanent Residence Address

JAMBAK JALUR 5,DISTRICT LUHAK NAN DUO,RESIDENC WEST PASAMAN,WEST SUMATERA ,INDONESIA
& Contact number

Relationship to the Beneficiary MOBILE

Bank Name BANK BNI (BANK NEGARA INDONESIA)

Bank Address and

SIMPANG 4 ROAD NO.46 WEST PASAMAN,WEST SUMATRA
Telephone number

Account Number 0359743415

Account Type

Savings/Checking/Dollar Account , etc.

IBAN Number

Swift Code

Note:
All the information given herein are valid, true and correct based on the attached bank letter or copy of my passbook. I have understood that the above given bank account will
be my permanent bank account to be submitted to the company and will no longer be changed unless for emergency reason/s.

Crew Signature Date