FORM: A/1

REPORT OF INSPECTION IN ACCORDANCE WITHE THE

MEDITERRANEAN MEMORANDUM OF UNDERSTANDING
ON PORT STATE CONTROL1)

-Master Copy to: People’s Democratic Republic Of Algeria

-Head office Ministry Of Transports
-PSCO Coast Guard National Service
If ship is detained, copy to: Maritime Affair’s Department
-Flag State Maritime Station Of Annaba
-Recognized organization, if applicable Street BENABDELMALEK Ramdhan - Annaba Address:
+213338454860 Telephone/ Fax:

SHIP PARTICULARS
1. Name of the ship: M/V CORONA J ...............................… 2. Flag of ship: ANTIGUA-BARBODA.......
3. type of ship: ........…CONTAINER SHIP........................… 4. Call sign: ………..…V2BG1 .........................
5. IMO number: ………….…9238686 …..............................… 6. Gross tonnage: ………16129 ..................…
7.Date keel laid /major conversion commenced (dd/mm/yy): .....… 08.09.2001 .......................................................
8. Deadweight (where applicable): …………17400 MT ………
9. Full particulars of company (identical to particulars as in the ISM DOC) **2:
IMO company number: 1346032 Name JUNGERHANS MARITIME SERVICES
GmbH & Co.KG ...................................................................
Address: Boschstrasse 31 , 49733 Haren /Ems / GERMANY .................................................................................
City: ………..........……… Country: …… GERMANY...............................................……..
10. Name and signature of master to certify that the information under 10 is correct:
Name: NORDEN AXEL Signature: …………...……...
INSPECTION PARTICULARS3)
11. Date of boarding ship: ...... 24/09/2019 ....... 12. Place of inspection: …... .ANNABA ….................…
13. If vessel is detained: Date of detention notice: …………………//…………...................…………...……………..
14. Date of final report: ….....…24/09/2019 ……................…………………………………..………………………..
15. Type of inspection Initial inspection More detailed inspection Follow-up inspection
4
(C.I.C ): Emergency Systems and Procedures
16. Follow-Up inspection(s):
Date ……………… Place ………… Authority ……………… By: …..…….…………………
: : :
Date ……………… Place ………… Authority ……………… By: ……………………………
: : :

17. Operational controls (if any): Abandon ship drill …………………..........................………………………

Fire drill ……………..........................……………………………
SOPEP drill …………………………….........................……………
SMPEP drill ………………………………………….........................
Damage control ………………………………………….........................
Other: ……...… ………………........................…………………………

1
This inspection report has been issued solely for the purpose of informing the master and the other port States that an inspection by the port State, mentioned
in the heading, has taken place. This report cannot be construed as a seaworthiness certificate in excess of the certificate the ship is required to carry.
2
Non-ISM ships: Master to supply and sign under 12 for correct full particulars of company
3
Master, Ship-owners and/ or Operators are advised that detailed information on the inspection maybe subject topublication (www.medmou.org)
4
Concentrated Inspection Campaign, aseparate questionnaire should be filed up and recorded into Cloned

FORM: A/2
 Name of ship: M/V CORONA J ……… IMO Number : 9238686 ………
18. Relevant certificate (s)
Relevant certificate(s) Last intermediate or annual survey
Issuing Dates of Date of Surveying
Title Date Place
Authority /RO issue expiry Authority /RO
SafeCon ....... DNV-GL..... 15-03-19 31-12-22 ....... DNV-GL..... 15-03-19 Turkey
SafeEqu ....... DNV-GL..... 03-07-19 31-12-22 ....... DNV-GL..... 15-03-19 Turkey
SafeRad ....... DNV-GL..... 15-03-19 31-12-22 ....... DNV-GL..... 15-03-19 Turkey
Safe Cargo …………… ………… ………… ……………… ………… ……..……………
SafePass …………… ………… ………… ……………… ………… ……..……………
LL ....... DNV-GL..... 15-03-19 31-12-22 ....... DNV-GL..... 15-03-19 Turkey
IOPP ....... DNV-GL..... 25-06-18 03-04-22 ....... DNV-GL..... 15-03-18 Turkey
IAPP ....... DNV-GL..... 15-03-19 31-12-22 ....... DNV-GL..... 15-03-19 Turkey
ISPP ....... DNV-GL..... 15-03-19 31-12-22 ……………… ………… ……..……………
DOC ......... NKK ........ 03-05-19 13-05-24 ……………… ………… ……..……………
SMC ....... DNV-GL..... 25-06-18 06-09-23 ……………… ………… ……..……………
ISSC ....... DNV-GL..... 25-06-18 05-08-23 ……………… ………… ……..……………
CSR .… Flag state …. 16-05-19 ………… ……………… ………… ……..……………
Min S Man .… Flag state …. 06-08-19 05-08-20 ……………… ………… ……..……………
Tonnage ....... DNV-GL..... 15-03-19 ………… ……………… ………… ……..……………
19. Classification society (les) responsible for issuance of class certificates:
……….…… ........ DNV-GL......… Issued on: ...15-03-2019.... Expired on: …31-12-2022….…
……….…………………….……… Issued on: ……………….. Expired on: ……......……..………
20. Recognized organization (s) responsible for issuance of certificates on behalf of the flag states
……………...…..... ... NKK........................….…....…………....……………………….............................……………………
………………… …………...........……….................................……………............……………………………………………

21. Ship related inspection action taken:

Flag state informed RO informed Next port informed
All deficiencies rectified Inspection suspended Overriding priority inspection
Ship allowed to sell after Other: ……………… MARPOL investigation
Ship detained
22. Deficiencies No Yes (see attached FORM B)
23. Supporting documentation No Yes (see annex)

PORT STATE PARTICULARS

District office………………………………………..…Maritime Station Of Annaba………...................................……
Address …………………………………………………Street BENABDELMALEK Ramdhan - Annaba….............
Telephone………………………………………………+213338454860 ……….…….............................................………
Fax……………………………………………………….+213338454860 ……….…….............................................………
E-mail ………………………………………………………………..…………/………….........................……...……………

Name: DJABALI ZINE

(duly authorized PSCO of reporting authority)

Signature ……..………….……

This report must be retained on board for a ported of at least two years and must be readily available for
consultation by Port State Control Offices at all times.