Doc. No.

: DFAC-SFAC-2168

CREW EXPENSE CLAIM FORM Prepared by: JA

Revision no.: 00

Mandatory Revision date: 12/17/2014

Document Last revised by: OS
Approved by: LPS
Date: 10/11/2020
Name: Alexander Prokopyev Position: Ch. Officer
Vessel: Normand Supra Last sign on: 8/20/2020 Last sign off: 5/28/2020

A: Transportation, Accommodation and Meals (Travelling A/C No. 57210)

Foreign Foreign Exchange
Date Country Description Amount in USD
Currency Amount Rate

5/28/2020 Sweden Meals -Dinner SEK 195 0.11363 22.16

Second luggage (was not included
5/29/2020 Sweden for Stocholm-Minsk flight) SEK 529 0.11363 60.11

5/29/2020 Belarus Taxi Minsk-St.Petersburg USD 350 1.00 350.00

8/4/2020 Russia Taxi Home-Airport RUB 1054 0.01302 13.72

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A: SUB-TOTAL 445.99

B: Seminar, Courses and Certificate fees (Training Costs Expats A/C No. 59120)
Foreign Foreign Exchange
Date Country Description Amount in USD
Currency Amount Rate
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B: SUB-TOTAL -

C: Medical expenses (Medical treatment A/C No. 59100)

Foreign Foreign Exchange
Date Country Description Amount in USD
Currency Amount Rate
7/9/2020 Russia Medical Fitness Examitation RUB 6700 0.01302 87.22
International Medical Fitness Cert
7/24/2020 Russia (was necessary to join N.Surfer) RUB 1700 0.01302 22.13
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C: SUB-TOTAL 109.35
Crew Signature:
GRAND TOTAL 555.35
Verified by: Approved by:
Crew Coordinator Senior Crew Coordinator