SCA-03

ALLOTMENT SLIP

NAME: SIGNATURE:
LAST NAME FIRST NAME MIDDLE NAME

POSITION: VESSEL:

ADDRESS:

BIRTHDATE: STATUS: CONTACT NO.:

SSS NO.: T.I.N.:

PHILHEALTH NO. PAG-IBIG NO.

PREVIOUS EMPLOYER:

ALLOTTEE 1: AMOUNT IN DOLLARS

RELATIONSHIP: CONTACT. NO.:

ADDRESS:

BANK/BRANCH: SAVING ACCT. NO.:

ALLOTTEE 2: AMOUNT IN DOLLARS

RELATIONSHIP: CONTACT. NO.:

ADDRESS:

BANK/BRANCH: SAVING ACCT. NO.:

ALLOTTEE 3: AMOUNT IN DOLLARS

RELATIONSHIP: CONTACT. NO.:

ADDRESS:

BANK/BRANCH: SAVING ACCT. NO.:

TOTAL ALLOTMENT. . . . . . .
PAY ON BOARD. . . . . . . . . .

PLEASE INDICATE NAME OF ALLOTTEE TO WHOM WE WILL DEDUCT THE FOLLOWING DEDUCTIONS:

SSS/PHILHEALTH/PAG-IBIG CONTRIBUTIONS:
SSS SALARY LOAN
CASH VALE/CASH LOAN/RCBC LOAN
MEDICAL (CHARGE TO SEAMAN)
TRAINING

FOR EMBARKING OFFICERS AND CREW WHO WILL JOIN THE VESSEL FROM 16TH UP TO END OF THE MONTH PLEASE
INDICATE NAME OF ALLOTTEE TO WHOM WE WILL DEPOSIT YOUR SALARIES (PRO-RATA)

ACCOUNT NAME :
RELATION :
BANK NAME & BRANCH :
ACCOUNT NUMBER :