Maritime Labour Convention, 2006:bijlage B4-I

Maritime Labour Convention, 2006

Appendix B4-I Model Receipt and Release Formreferred to in Guideline B4.2.2

Geldend

Deze functie is alleen te gebruiken als je bent ingelogd.Deze functie is alleen te gebruiken als je bent ingelogd.Deze functie is alleen te gebruiken als je bent ingelogd.Deze functie is alleen te gebruiken als je bent ingelogd.Deze functie is alleen te gebruiken als je bent ingelogd.

Ship (name, port of registry and IMO number): .....

Incident (date and place): .....

Seafarer/legal heir and/or dependant: .....

Shipowner: .....

I, [Seafarer] [Seafarer’s legal heir and/or dependant]*hereby acknowledge receipt of the sum of [currency and amount] in satisfaction of the Shipowner’s obligation to pay contractual compensation for personal injury and/or death under the terms and conditions of [my] [the Seafarer’s]* employment and I hereby release the Shipowner from their obligations under the said terms and conditions.

The payment is made without admission of liability of any claims and is accepted without prejudice to [my] [the Seafarer’s legal heir and/or dependant’s]* right to pursue any claim at law in respect of negligence, tort, breach of statutory duty or any other legal redress available and arising out of the above incident.

Dated: .....

Seafarer/legal heir and/or dependant: .....

Signed: .....

For acknowledgement:

Shipowner/Shipowner representative:

Signed: .....

Financial security provider:

Signed: .....

Deze functie is alleen te gebruiken als je bent ingelogd.