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Evidencija o primicima od nesamostalnog rada u . godini

I. Opći podaci o članu posade broda u međunarodnoj plovidbi
Ime i prezime
Adresa:
OIB:
II. Izračun pomorskog dodatka
R. br. Broj dana u plovidbi Iznos pomorskog dodatka po danu
plovidbe (u kunama i lipama)
1 2 3

Ukupan iznos pomorskog dodatka

III. Utvrđivanje dohotka od nesamostalnog rada
R. br. Opis
1 2

1 Ukupni primici (plaća)

2 Ukupni pomorski dodatak
3 Primici (r.br. 1. – r. br. 2.)
4 Izdaci za doprinose za obvezna osiguranja
5 Dohodak od nesamostalnog rada (r. br. 3. – r. br. 4.)
IV. Prilozi
1.                                                                                                                                                                                 
2.                                                                                                                                                                                 
3.                                                                                                                                                                                 
4.                                                                                                                                                                                  
5.                                                                                                                                                                                 
U _, godine                                                                                                      
(potpis člana posade broda u međunarodnoj plovidbi)
 Ukupan iznos pomorskog dodatka (u
kunama i lipama)
4

Iznos (u kunama i lipama)

3