FORM SHIP INSPECTION

Ship Name
IMO NUMBER
Owner / Operator
Company Phone
Email
Ship Particular & Operational:
Ship Type ☐ Tanker ☐SPOB ☐OB ☐TB (Other:...………………….)
Charter Type ☐TC ☐VC (Other:………………………………………)
GT & DWT Flag
Year Built Classification ☐ Non Class
Length Over All Mtrs Type of Cargo
Breadth Mtrs Hull Type ☐ Single ☐ Double - Hull
Bottom Type ☐ Single ☐ Double - Bottom
Mark as applicable system and or ships operational on board?
☐ Pump room ☐ STS operational ☐ Mother ☐ Shuttle-Tanker
☐ Inert gas system installation ☐ Single point mooring operation
Expiry Date Expiry Date
Certificate Certificate
(dd/mmm/yy) (dd/mmm/yy)
Class Certificate Safety Management Cert.
Load line Certificate Document of Compliance
Safety Equipment Cert. Gas Fitness Cert. (if
applicable)
Safety Radio Certificate Civil Liability Conv.
(1992)(>2000DWT)
Safety Construction Cert. Marine Pollution Insurance
(>500GT)
IOPP Certificate Calibration Table
Izin Angkut MIGAS
SIUPAL
History Cargo Loading / Discharge
Last Cargo
*VEF
Pipeline & Cargo Tank Diagram
*Document Loading and Discharge for 10 Voyage Available : ☐ Y ☐N

Sign Company Stamp

Name

Position