STATEMENT OF WAGE CLAIM On XXX, in XXX, the claimant, second engineer of m/v XXX, on the one hand, and XXXX, represented by plenipotentiary representative XXXX, acting on the basis of the power of attorney issued on XXXX, apostille of Seychelles dated XXXX, and XXXX, represented by Director XXX, acting on the basis of the Charter, on the other hand, concluded the tripartite Agreement No XX on wage arrears payment, according to clause 1 of which the shipowner - XXXX admitted wage arrears for the claimant in the amount of XXXX US dollars for the periods from XXXX through XXXX and from XXXX through XXXX, including bonuses, as of XXXX, inclusive, according to the estimation table presented in Annex No XX to the Agreement, which is based on the specific tariff rates and official salaries established in an individually signed sailor's employment contract. According to clauses 4.1-4.3 of this Agreement, wage arrears repayment schedule is provided. The final settlement of wage arrears in the amount of XXXX, according to the Agreement and Annex No 1 to it, must be performed by XXXX. In addition, according to clause 7 of the concluded Agreement, after full payment of the arrears by the shipowner - XXXX, specified in clause 1 of the Agreement, the claimant undertook to confirm the absence of any claims against the shipowner and the company in the written form.