Number of
Number of Number of
No. Vessel Name Transfer to Bank Account Location/ Charterer Passenger Days Food/Person Total Crew Food Remark
Crew Others (Cadet)
(CB/not)
1 KM STB 14 3040338887 BCA FREDY MUHAMAD FRIADY PONTIANAK 14 1 IDR 15 IDR 40.000 IDR 9.000.000
IDR -
IDR -
Total IDR 9.000.000
Remark
1) Transfer of fund shall be to Vessel Master only
2) Supporting Document should be provided for the requested amount (Crew List with date stamp)
3) Computation in details / explanation including special request (passenger) should be reflected in the form
4) Food Allowance transfer for 15 days
Rev 1
PERUSAHAAN PELAYARAN
PT. LINTAS BAHARI NUSANTARA
Kantor Pusat: Jl. Pluit Raya No. 67B Jakarta Utara-Indonesia
Telp: 021-6619941 Fax: 021-6612790
Kantor Cabang: Jl. Kom. Yos Sudarso Gg. Klontan 3 No. 53 Pontianak
Telp: 0561-774731 Fax: 0561-777660
4. ZAILANI KKM 4.
Dengan ini memberikan kuasa penuh untuk menerima UANG MAKAN dan UANG KAS, kepada yang tersebut
dibawah ini :
Master