BUE CYPRUS LIMITED EXPENSES CLAIM FORM

FULL NAME: __________________________________ PAYROLL REF: _____________

RANK: ______________________________

EXPENSES JOINING OR LEAVING A VESSEL

Date	Description	Vessel	No. of Miles	Total

Sub Total _____________

EXPENSES INCURRED AT TRAINING COURSES

Date	Description	No. of Miles	Total

Sub Total _____________

MEDICAL EXPENSES

Date	Description	No. of Miles	Total

Sub Total _____________

MISC EXPENSES

Date	Description	No. of Miles	Total

Sub Total _____________

SIGNED BY APPLICANT __________________________________________ Total Due _______________

AUTHORISED BY MASTER ________________________________________ Date ___________________

AUTHORISED BY CREW MANAGER ________________________________ Date ___________________

Notes:

1. Payroll reference should be quoted on all expense claim forms to avoid errors in payment

2. Number of miles should only be filled in if you are claiming mileage

3. Do not use this form to request leave encashment. Ask Master for appropriate form

4. Any expenses not authorised will be returned to Master

5. Please attach expenses receipts to the back of the form. Petrol receipts are not required for mileage claims

Form DCS 01/04/01