Port : _____________ Date : _____________ To _________________________ _________________________ Ref: Cargo Samples Cargo / Cargoes : _________________ To be loaded in / discharged from*

Tanks : __________________________________________ Dear Sir, Please be advised that samples of the captioned cargo are to be taken jointly by you and my authorised representative Mr. ___________________, Rank ____________ as follows: 1. Manifold sample at time of commencement of laoding / discharge*. 2. Cargo tank sample from each cargo tank upon completion of loading / prior commencement of discharge*. 3. Foot samples from the cargo tank after approximately one foot of cargo has been loaded*. 4. Manifold composite sample during loading / discharge*. * Delete as appropriate These joint samples are to be sealed and marked to clearly indicate the following information: a) b) c) d) e) Name of vessel Type of cargo Port of loading/discharge Detail of sample (Manifold sample, tank sample etc). Name and signature of Chief officer and Surveyor or Terminal representative.

One set of sealed and signed samples will be retained by the vessel. If you require additional samples for shippers or receivers then kindly ensure that sufficient quantity of sample is taken so that all parties can be provided with requisite samples: My vessel will not commence loading / discharge unless you agree to comply with the sampling requirements. My vessel will not be responsible for any delays, costs or consequences whatoever arising out of your failure to comply with the above. Kindly sign below to acknowledge receipt and compliance.

_______________________ MASTER M.T.___________________

__________________________ SIGNATURE ___________________________ NAME

TKR 13

REV 0 / 10-02