CREW ALLOTMENT FORM

1) Every seafarer must have a bank account for salary remittance.

(Please select one)

To remit All Earnings except Basic Wage & Trade Allowance to be paid onboard

To remit All Earnings including Basic Wage & Trade Allowance,

vv no payment to be made onboard
To retain by Company All Earnings except Basic Wage & Trade Allowance pay onboard
To retain by Company All Earnings including Basic Wage & Trade Allowance,
no payment to be made onboard
To remit to Manning Agent All Earnings except Basic Wage & Trade Allowance pay onboard
To remit to Manning Agent All Earnings including Basic Wage & Trade Allowance,
no payment to be made onboard
*** Final wage payment & leave pay will be remitted to personal account or manning agent upon sign off
from vessel.
2) Details in this form shall be typed or handwritten neatly and submitted to Crewing
Dept upon sign on.
3) Remittance will be made on / around 15th day at each month, with effect from sign
on.
4)* Subsequent amendment to Bank Details would be charged Administrative Fees of US$20.00.
(Cancellation upon signoff will not be charged).
5) Bank charges are on crew's account.
6) Company shall not be held liable for remitting of fund into wrong account or be held
responsible for any delay in remitting the fund due to inaccurate banking details
and/or information provided by the seafarer and government sanction.
7) The provision of allotment arrangement is for the convenience of seafarer in
managing the distribution of his/her monthly income. The company shall not be held
responsible should there be any dispute between the seafarer and the beneficiary or
any third party nominated by the seafarer after the remittance is made as per the
seafarer’s instruction.
8) Form received after 20th of the month will only be processed in the following month.
9) Crew is to retain a copy for own reference.
Crew Details

Name: Iman Iriyanto Vessel: MT. Ocean Princess

Passport No : B 3370769
th Rank: Chief
th Officer
Date of Birth: 16 October 1980 Date joined: 14 June 2017
Nationality: Indonesian

(Please select one)

I confirm this is my first allotment request
I confirm I want to change my bank details as follows (See Note 4 *)

Remittance Details
Name of Beneficiary: Dwi Lestari
Beneficiary's Bank: CIMB Niaga

Bank Address: CIMB Niaga Cab. Yogykarta Jl. Jenderal Soedirman

Bank Account No: 701 454 632 340

Correspondent Bank: -
Note: Retention period of completed form is 7 years
OT/C/CRW/0512/019
 (leave blank if not known)

To cancel remittance instruction upon sign off? Yes No

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I confirm the account information provided is correct and have read and understand the terms and conditions set
up by the company for salary remittance and allotment arrangement.

Iman Iriyanto / 27th July 2017

Crew signature / Date

Capt. Ahira Sroyer

Verified by Master/Agency

Accounts Department use only

CC: crew file

Note: Retention period of completed form is 7 years

OT/C/CRW/0512/019
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Note: Retention period of completed form is 7 years

OT/C/CRW/0512/019