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: 11 Aug 2024
J. RAY MCDERMOTT, S.A. |
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| Name of Seaman/Landworker: |
MATERIAL CLERK Van Allen M. Fortaleza |
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| Address: |
#27 De Aro St., Mabayuan, Olongapo City |
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| Mcdermott Crew Badge No.: |
24J80-70/day |
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| Basic Pay |
US$ |
1,448.00 |
| Fixed O.T. |
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434.40 |
| Leave Pay |
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217.60 |
| Others (Specify) |
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0.00 |
| Total |
US$ |
2,100.00 |
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| Name of Allottee |
Vivian M. Fortaleza |
Allottee # 1 |
| Relationship |
Mother |
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| Address |
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| Amount of (in Figures) |
$ 120.00 |
| Allotment (in Words) |
One Hundred Twenty Dollars and 00/100 |
| Bank/Branch |
BDO - Olongapo Branch |
| Account # (Peso) |
007700112778 |
| Signature |
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| Name of Allottee |
Van Allen M. Fortaleza |
Allottee # 2 |
| Relationship |
Self Allottee |
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| Address |
Same as above |
| Amount of (in Figures) |
$ 1,980.00 |
| Allotment (in Words) |
One Thousand Nine Hundred Eighty Dollars and 00/100 |
| Bank/Branch |
BDO - Olongapo Branch |
| Account # (Peso) |
005830444268 |
| Signature |
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| Employees Signature | |
| Vessel Assignment | Mc Dermott Derrick Barge 30 |
| Month of Effectivity | Aug 2024 |
| S.S.S. # | 02-3125173-8 |
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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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