ISM SHIP MANAGEMENT PTE LTD G22

Rev 00/16 Apr 2015

SUPPLIER BANK ACCOUNT CONFIRMATION SHEET Page 1 of 1

Vessel Name:
(hereinafter referred to as the VESSEL)

Port:
Date:
Supplier's Name:
(hereinafter referred to as the SUPPLIER)

Supplier's Telephone
Supplier's Fax
Product/service supplied:
Invoice No.(s):
(hereinafter referred to as the INVOICE)

Net amount payable:

The SUPPLIER requests the VESSEL's owner or manager to remit product/service expense as per
the INVOICE amount to following bank account. The VESSEL and her owner/manager shall be released
of any liability to the SUPPLIER once full amount as per INVOICE has been remitted to the bank account
stated hereinafter.

Bank Name:
Beneficiary Name:
A/C No.:
Swift Code:

Confirmed by (sign & stamp),

Supplier's Representative Master

Name: Name:

IMPORTANT:
1) Remittance will be made to company account only. No personal account will be accepted.
2) In principle, benficiary name should be same as supplier's company name.
3) Delivery order/receipt/invocie must be accompanied by this bank account confirmation sheet.
4) We willl only accept bank account confirmation sheet submitted by vessel fax.