EMPLOYEE COMPLAINT FORM

It is the purpose of the Complaint Procedure to establish a method whereby complaints of employees
will be resolved fairly and effectively. The filing of a complaint will in no way prejudice the status of
the employee.

EMPLOYEE: DATE:

DEPARTMENT: JOB TITLE:

STATEMENT OF COMPLAINT (Background/activity leading to complaint, including dates):

REMEDY REQUESTED:

______________________________________________________________________________________

EMPLOYEE'S SIGNATURE: __________________ DATE: __________________________

Date the Master was notified: (Please attach

__________________________________________
response)

Date the DPA was notified: (Please attach ___________________________________________

response)

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Employee Inquiry and Complaint Procedures:

Supervisors and employees should mutually strive to develop and maintain good working relationships. The
company encourages open and honest dialogue about work standards and performance. If such discussion does not
prevent or solve a problem, additional actions may be taken, and more formal procedures are available. The
company prohibits retaliation against any employee for use of, or participation in, such procedures.

If the employee has questions concerning policies and procedures affecting or likely to affect his work, there are
resources available for clarification. Therefore, he is encouraged to seek answers to his work-related questions and
concerns. There are three methods available for addressing employee relations problems:

1. General Inquiry
2. Informal Complaint Procedure
3. Formal Complaint Procedure

1. General Inquiry
If you believe that you have been inappropriately treated or you desire clarification of Company policies and
procedures and are unable or prefer not to talk to your immediate department officer about the questions, you are
encouraged to contact the Master of the ship.

2. Informal Complaint Procedure

If a problem remains unresolved after using the general inquiry process, you may elect to initiate a request for
redress through the informal complaint procedure. You should attempt to first discuss the problem with your DPA.
The DPA’s responsibility is to meet in a timely and professional manner with you to discuss the applicable Company
policies. DPA should consider reasonable solutions that would remedy the situation consistent with Company
policy.

If you believe that you are not able to direct the particular work-related concern to an immediate DPA, you should
discuss the matter with another appropriate departmental administrator. You may also contact the Crewing

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Department, the Designated Person Ashore, or the Operations Department for additional assistance in resolving
your complaint(s).

3. Formal Complaint Procedure

The term “formal complaint” refers to a written complaint concerning the interpretation or application of a specific
term or provision of Company or department policy, or concerning a disciplinary act alleging that the application of
such procedure or criteria was clearly erroneous, arbitrary, or capricious. Formal complaints involving discretionary
decisions will be processed solely with respect to whether or not prescribed procedures were followed and/or
whether or not prescribed criteria, if any, were observed.

Formal procedures, when necessary, are available to crewmembers for the efficient handling and equitable hearing
of complaints. The following complaint procedure covers only those regular Company crewmembers in classified
positions who have successfully completed the initial provisional period of employment. If a crewmember is serving
the initial provisional period or any extension of it, the Company’s formal complaint procedure may not be invoked.
The crewmember is eligible, however, to use the informal complaint procedure unless and until the crewmember is
dismissed. The complaint procedure outlined below is the only authorized procedure to be invoked for resolving
formal employee complaints.

Scope of the Formal Complaint Procedure

The formal complaint procedure is intended to resolve disputes concerning application of policies and procedures
governing personnel practices at the Company, including the Company policy on docking of pay. Certain matters,
such as restrictions or limitations placed upon the Company by its insurance carriers or issues regarding
performance appraisal, job classification of crewmembers—other than improper docking claims—are not subject to
the formal complaint procedure.
If you have questions or concerns about the formal complaint procedure, you should contact the Crewing
Department, the Technical Department, or the Operations Department.

Processing a Formal Complaint

You may file a formal complaint only after a general inquiry and/or an informal complaint fails to resolve the
problem. The formal complaint procedure involves three steps.
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Level I — Presentation of the formal complaint to the DPA

Level II — Appeal to the Crewing Manager, Operations Manager or the General Manager.
Level III — Formal Complaint to the Flag State Complaint Office.
The formal complaint must be in writing on the Formal Statement of Complaint form and must be signed and dated
by you. This form is available from the ship Master, Chief Officer or the Company Crewing Department. The Formal
Statement of Complaint must:

- Explain the nature of the complaint and the specific circumstances at issue,
- Identify the rights, procedures, or policies violated, and
- State the specific and complete remedy sought by you.
Once the complaint is written and submitted, no aspect of it can be expanded or modified.

The Formal Complaint can only be presented at Level III, if the crewmember is able to prove that he presented his
complaint in according to the above stated procedure, to all company concerned parties, from the immediate
responsible officer at the General Inquiry Level, up to the General Manager in the Formal Complaint Level II, and
the complaint has not been dealt with satisfactorily in order to meet the crewmember demands.

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COMPLAINTS HANDLING PARTIES CONTACT DETAILS:

PALAU INTERNATIONAL SHIP REGISTRY

Houston: Greece:
16701 Greenspoint Park 5, Sachtouri Street, Piraeus,
Drive, Suite 155 77060 18536, Greece
T: +1 281 876 9533 T: +30 210 4293500
F: +1 281 876 9534 F: +30 210 4292503
antonia.chatzikonstanti@palaureg.com
www.palaureg.com

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