Wallem Maritime Services Inc.

WMSI Allotment Slip Form

Reference No : Auto Generated

Last Name

First Name

Middle Name

Suffix Name

Position / Rank

Vessel Assignment

*with deductions

Allotee Name

Relationship

Address

Contact No

Email Address

Bank Name

Bank Branch

Account No

Amount (in USD)

Click the box to add a second Allottee?

Allotee Name

Relationship

Address

Contact No

Email Address

Bank Name

Bank Branch

Account No

Amount (in USD)

Click the box to add a third Allottee?

Allotment Type

Allotee Name

Relationship

Address

Contact No

Email Address

Bank Name

Bank Branch

Account No

Amount (in USD)

Click the box to add a fourth Allottee?

Allotment Type

Allotee Name

Relationship

Address

Contact No

Email Address

Bank Name

Bank Branch

Account No

Amount (in USD)

Sign and Submit

“You acknowledge that by clicking on the Sign Document button or similar button on this page, you are indicating your intent to sign the relevant document (WCMS Allotment Slip Form) or record and that this will constitute your signature.”