Inspecting Company’s letterhead

LETTER OF INDEMNITY

To:
PT PELAYARAN KORINDO
WISMA KORINDO
Jl, MT HARYONO Kav 62
Jakarta, 021-7975959

Dear Sirs,

We, [Name of Employer] request that you give permission for Mr. [Name of Employee and PP
no.] (hereinafter the employee) to visit your vessel namely MT GAS LAMIWURI 01

In consideration of your complying with this request, we hereby agree as follows:-

1. To indemnify you, your servants or agents and to hold all of you harmless in respect of
any liability for negligence, breach of duty, statutory or otherwise, or for any other cause
whatsoever, loss or damage of whatsoever nature which you may incur by reason of any
injury, sickness, loss of life, damage to or loss of property or personal effects which may
be sustained by the employee.

2. To indemnify you, your servants or agents and to hold all of you harmless in respect of
any liability for negligence, breach of duty, statutory or otherwise, or for any other cause
whatsoever, loss or damage of whatsoever nature which you may incur by reason of any
injury, sickness, loss of life damage to or loss of property or personal effects which may
be caused by the employee.

3. In the event of proceedings being commenced against you or any of your servants or
agents in connection with Clause 1 and 2 above, either to provide you or them with
sufficient funds on first demand to defend the same or, if requested by you, to assume the
defence of the claim,

4. To undertake that no claim will be made or proceedings brought by us in respect of any

loss or damage, costs or expenses which we may sustain as a result of any act or default
whether negligent or not on the part of the employee.

5. To maintain adequate insurance to cover our liabilities under this indemnity. A copy of
which is to be provided on written request.

6. This indemnity shall be construed in accordance with English law and each and every
person liable under this indemnity shall submit to the jurisdiction of the English High
Court to the exclusion of any other law and any other jurisdiction. It is understood and
agreed that the Owners of the ship in respect of which this indemnity is given shall be
Inspecting Company’s letterhead

entitled to the maximum protection allowed by English law, including statutory

protection of limitation as to the amount of damages recoverable.

The undersigned hereby acknowledges that this is a form of indemnity and agrees to be
legally bound by the terms and conditions contained in this document.

Date,…………………………… 2023

Yours faithfully,
[signed by an authorized signatory on behalf of Employer]