CLAIM / REIMBURSEMENT FORM

Company Name : SINANJU TANKERS Pte Ltd

Application Name : ARIEF WIDAYAT

Designation : CHIEF OFFICER Dept/Barge : MARINE SELENA

Please complete this form in full and attach bills, receipts and relevent documents
in support of claim, if any.

S/N Date Particulars Amount

LAUNCH TRANSPORTATION WHILE ON/OFF DAY
1 31 Jan 2020 SOTONG BOAT FROM AEPB TO MSP SGD 20.00
2 2 Mar 2020 SOTONG BOAT FROM MSP TO AEPB SGD 20.00

SGD 40.00

The Sum of Dollars : FORTY DOLLARS ONLY

I hereby confirm that the above informations provided are correct.

For Office Use

Ref / A/C : ___________________

Applicant signature
Date: 16-Mar-20 Vessel : ___________________
Rank: CHIEF OFFICER Checked : ___________________

Approved : ___________________

Master Approval
Date: 16-Mar-20
Rank: MASTER
 CLAIM / REIMBURSEMENT FORM

Company Name : SINANJU TANKERS Pte Ltd

Application Name : Wasis Anggono

Designation : 2nd Engineer Dept/Barge : MARINE SELENA

Please complete this form in full and attach bills, receipts and relevent documents
in support of claim, if any.

S/N Date Particulars Amount

transportation for renewal work permit to seacare
1 30-Dec-19 Grab From office to seacare Medical Clinic SGD 9.00
2 30-Dec-19 taxi city cab From Seacare medical Clinic to West Coast Pier SGD 10.05

SGD 19.05

The Sum of Dollars : nineteen dollars only

I hereby confirm that the above informations provided are correct.

For Office Use

Ref / A/C : ___________________

Applicant signature
Date: 16-Jan-20 Vessel : ___________________
Rank: 2ND Engineer Checked : ___________________

Approved : ___________________

Master Approval
Date: Moh hasan
Rank: Master