Pacific Seamen Services, Inc.
3F Unit 33, 34 & 35 Columbia Tower, Ortigas Avenue Mandaluyong City
Telephone Nos.: (632) 7444546 * (632) 7268927
Fax Nos.: (632) 7444548
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| Allotment Instruction Form | | ETD:
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| Name of Seaman/Landworker: |
Vergilio Roselito Jr. M. Dumo |
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| Address: |
#251 Pagudpud, San Fernando City, La Union |
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| Mcdermott Crew Badge No.: |
28778 |
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| Basic Pay |
US$ |
2,793.00 |
| Fixed O.T. |
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837.90 |
| Leave Pay |
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419.10 |
| Others (Specify) |
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0.00 |
| Total |
US$ |
4,050.00 |
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| Name of Allottee |
Christian T. Dumo |
Allottee # 1 |
| Relationship |
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| Address |
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| Amount of (in Figures) |
$ 130.00 |
| Allotment (in Words) |
One Hundred Thirty Dollars and 00/100 |
| Bank/Branch |
BDO - San Fernando, La Union |
| Account # (Peso) |
4430-21356-1 |
| Signature |
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| Name of Allottee |
Wilma Tabbada Dumo |
Allottee # 2 |
| Relationship |
Wife |
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| Address |
#251 Pagudpud San Fernando City La Union |
| Amount of (in Figures) |
$ 1,000.00 |
| Allotment (in Words) |
One Thousand Dollars and 00/100 |
| Bank/Branch |
BDO - San Fernando, La Union |
| Account # (Peso) |
4430-01443-7 |
| Signature |
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| Name of Allottee |
Dumo, Vergilio Roselito Jr. M. |
Allottee # 3 |
| Relationship |
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| Address |
#251 Pagudpud San Fernando City La Union |
| Amount of (in Figures) |
$ 2,920.00 |
| Allotment (in Words) |
Two Thousand Nine Hundred Twenty Dollars and 00/100 |
| Bank/Branch |
BDO - San Fernando, La Union |
| Account # (Peso) |
4430-02161-1 |
| Signature |
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| Employees Signature | |
| Vessel Assignment | |
| Month of Effectivity | |
| S.S.S. # | 33-0799920-6 |
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| File Copies | Master
Crewmember
Principal
201 File
Accounting |
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| Rev. 2.1 May 2003 | OPS/GEN-007 |
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I, , pursuant to Section 8 of the Standard Terms
and Conditions Governing the Employment of Filipino Seafarers, hereby instructs Pacific Seamen Services, Inc. to
deposit at least
80% of my basic salary to any authorized Philippine Bank.
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Employee's signature over printed Name |
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