Vessel Owner (Employer) - Crewman Agreement printable pdf download

Vessel Owner (Employer) - Crewman Agreement

Fl–41Vessel Owner (Employer) – Crewman Agreement

Regarding Medical and Related Transportation or Other Expenses

, vessel owner/operator of the F/V

and

, crewman on this vessel have agreed that any medical

related expenses paid by the said vessel owner or operator are not business expenses of the

vessel and were paid as a loan to the said crewman or paid directly to the provider of the

services. If a loan, these expenses have been or will be deducted from the crewman’s share or

be paid.

Further, any expenses eligible for reimbursement by the Alaska Commercial

Fishermen’s Fund that have been paid by the vessel owner are authorized by the said crewman

to be paid directly to the said vessel owner or operator. A Social Security number must be

provided for the vessel owner in order to reimburse payment to him/her.

_____________________________________________ _______

Date ___________

Vessel Owner Signature and Address

_____________________________________________________

Vessel Owner Social Security/Tax I.D. Number

_____________________________________________________

Date ____________

Crewman Signature

________________________________________

Crewman Claim Number

12/5/00 Rev.

Vessel Owner (Employer) - Crewman Agreement