PERMOHONAN SURVEY

APPLICATION FOR SURVEY

KEPADA :

NO.
TGL.

BIRO KLASIFIKASI INDONESIA

TO.

DATE

DENGAN INI KAMI MOHON AGAR SAUDARA MELAKSANAKAN SURVEY TERHADAP KAPAL BERIKUT INI
WE REQUEST YOU TO CARRY OUT SURVEY(S) FOR THE FOLLOWING SHIP :

NAMA KAPAL

PEMILIK

KLASIFIKASI

BKI

BENDERA

INDONESIA

SHIP'S NAME
OWNER

CLASSIFICATION

FLAG

NO. REG. :

REG. NO.

TANDA PANGGILAN :

CALL SIGN

KELAS LAIN :

OTHER CLASS

BENDERA ASING :

OTHER FLAG

SURVEY YANG DILAKSANAKAN :

SURVEY TO BE CARRIED OUT

1.

SURVEY KELAS

CLASS SURVEY

PENERIMAAN KELAS B.B.

PENERIMAAN KELAS B.L

SURVEY PEMBARUAN KELAS

SURVEY PERPANJANGAN KELAS

SURVEY PENGEDOKAN

SURVEY BAWAH AIR

SURVEY BOTOL ANGIN

SURVEY KETEL

SURVEY BERSAMBUNG MESIN

PENUNDAAN SURVEY POROS BALING-2

SURVEY BERSAMBUNG LAMBUNG

PENUNDAAN SURVEY PENGEDOKAN

ADMISSION TO CLASS NEWBUILDING

CLASS RENEWAL SURVEY

SURVEY OTOMASI

AUTOMATION SURVEY

SURVEY KHUSUS

POSTPONEMENT FOR PROP. SHAFT SURVEY

CONTINUOUS HULL SURVEY

OCCASIONAL SURVEY

SURVEY LAIN :

POSTPONEMENT FOR DOCKING SURVEY

OTHER SURVEY

SURVEY INSTALASI PENDINGIN

REFRIGERATING INSTALLATION SURVEY

SURVEY PEMBARUAN
SPESIAL SURVEY

SURVEY TAHUNAN / ANTARA

ANNUAL / INTERMEDIATE SURVEY

SURVEY PEMUATAN

KHUSUS

LOADING SURVEY

OCCASIONAL

SURVEY PERALATAN BONGKAR MUAT DAN ALAT PENGGERAKNYA

CARGO HANDLING MACHINERY AND GEAR SURVEY

EMPAT/ LIMA TAHUNAN

QUADRENNIAL / QUINQUENNIAL

TAHUNAN

KHUSUS

OCCASIONAL

ANNUAL

SURVEY GARIS MUAT

LOAD LINE SURVEY

SURVEY PEMBARUAN
PERIODICAL SURVEY

5.

SURVEY POROS BALING-2

PROPELLER SHAFT SURVEY

BOILER SURVEY

CONTINUOUS MACHINERY SURVEY

4.

SURVEY ANTARA

INTERMEDIATE SURVEY

IN WATER SURVEY

AIR RECEIVER SURVEY

3.

ANNUAL SURVEY

EXTENTION FOR CLASS RENEWAL SURVEY

DOCKING SURVEY

2.

SURVEY TAHUNAN

ADMISSION TO CLASS EXISTINGSHIP

TAHUNAN

KHUSUS

PERIODICAL LOAD LINE INSP.

OCCASIONAL

SURVEY STATUTORIA DAN SURVEY PENCEGAHAN PENCEMARAN DI LAUT

SOLAS SURVEY AND MARPOL SURVEY

KESELAMATAN KONSTRUKSI ( PERTAMA /PEMBARUAN / TAHUNAN WAJIB / ANTARA / KHUSUS )

SAFETY CONSTRUCTION ( INITIAL / PERIODICAL SURVEY / MANDATORY ANNUAL SURVEY / INTERMEDIATE SURVEY / UNSCHEDULED INSPECTION )

SURVEY PENCEGAHAN PENCEMARAN OLEH MINYAK

( PERTAMA / PEMBARUAN / TAHUNAN / ANTARA / KHUSUS ) .

SURVEY MARPOL ( INITIAL / PERIODICAL SURVEY / ANNUAL SURVEY / INTERMEDIATE SURVEY / UNSCHEDULED INSPECTION )

SURVEY KELAYAKAN ( FITNESS ) ( KAPAL TANGKI GAS / KAPAL TANGKI KIMIA / NLS )
( PERTAMA / PEMBARUAN / TAHUNAN WAJIB / ANTARA / KHUSUS )
FITNESS SURVEY ( GAS TANKER / CHEMICAL TANKER / NLS ) ( INITIAL / PERIODICAL SURVEY / MAS / INTERMEDIATE SURVEY / UNSCHEDULED INS. )

KESELAMATAN PERLENGKAPAN ( PEMBARUAN / TAHUNAN WAJIB / ANTARA / KHUSUS )

SAFETY EQUIPMENT ( PERIODICAL SURVEY / MANDATORY ANNUAL SURVEY / UNSCHEDULED INSPECTION )

KESELAMATAN RADIO ( PEMBARUAN / KHUSUS )

SAFETY RADIO ( PERIODICAL SURVEY / OCCASIONAL SURVEY )

B.

TEMPAT DAN TANGGAL SURVEY :

PLACE AND DATE OF SURVEY

BIAYA SURVEY YANG TIMBUL AKAN DIBAYAR OLEH :

SURVEY FEES AND EXPENSES ARISE ARE PAID BY

NAMA DAN ALAMAT :

NAME AND ADDRESS

PEMOHON SURVEY
APPLICANT'S SIGNATURE

BERI TANDA x PADA KOTAK

MARKED X IN BOXES

RESET
S.002-1997

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