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SAFETY RADIO SURVEY REPORT FOR VESSELS UNDER THE GMDSS

To meet provisions of the International Convention for the Safety of Life at Sea, 1974 as modified by the Protocol of 1988 relating thereto

INITIAL SURVEY RENEWAL SURVEY

Y PERIODICAL SURVEY

Mark “YES” or “NO” by a circle in appropriate box for each item. If an item is not applicable mark “NA” in appropriate
box. All negative entries should be clarified under “Surveyor’s Notes” with reference to the item number.
All required dates should be recorded at these surveys as dd/mm/yy.

Rep. No

Name of Ship Distinctive Port of Registry Gross Deadweight1 IMO Number

Number or Letter Tonnage

INW1 HP8782 PANAMA 406 N/A 8112809

Previous Name and Nationality of the ship: Name of any known sister ship: N/A
N/A

Name, address and telefax of

Owners:
INTERNATIONAL NAVAL WORKS (INW)
Managers:
MARINE INTERNATONAL SERVICES
Date on which keel was laid or ship was at a similar stage of construction or, where applicable, date on which work for a conversion or an
alteration or modification of a major character was commenced: _______1982__________________2

Builders (name/place): Yard Nº.

SINGAPUR, SOUTHERN OCEAN SHIPBUILDING CO/OSMANCO SHIPYARD(R)
Type of ship: Oil tanker Combination carrying oil or solid cargoes in bulk.
Chemical tanker Y Cargo ship other than any of above
Gas carrier

Sea areas in which vessel is certified to operate (Reg. IV/2.1.12 - 2.1.15)

Y A1 A1 + A2 + A3

A1 + A2 A1 + A2 + A3 + A4

Place of Survey: in drydock on slipway Y afloat Survey commenced2:

26/02/2017

At: ABO QIR.EGYPT Survey completed2:

26/02/2017

1
FOR OIL TANKERS, CHEMICAL TANKERS AND GAS CARRIERS ONLY
2
ALL REQUIRED DATES SHOULD BE RECORDED AT THESE SURVEYS AS DD/MM/YY
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TO BE CONFIRMED EVERY INITIAL / PERIODICAL / RENEWAL SURVEY 1

1. For radio installations, including radio life-saving appliances, of cargo ships the examination of current certificates, records and
documentation should consist of:

1.1 Checking the validity, as appropriate of:

CERTIFICATES AND MANUALS Issued by Expiry date Last Annual Entry date
Cargo Ship Safety Construction Certificate
Cargo Ship Safety Equipment Certificate
Record (Form E)
Cargo Ship Safety Radio Certificate
Record (Form R)
Safety Management Certificate (SMC)
Document Of Compliance (DOC)
International Load Line Certificate / Exemption
International Oil Prevention Pollution Certificate
Form A / Form B1
International Air Prevention Pollution Certificate
Supplement for IAPP
International Ship Security Certificate (ISSC)
International Anti-Fouling System Certificate
Class – Machinery
Class – Hull

1.2 Checking that the ship’s complement complies with the Minimum Safe Manning Document (SOLAS 74/88 YES
reg.V/13(b));

1.3 Checking that adequate information is on board to enable the equipment to be properly operated and YES
maintained;

1.4 Checking that the master, officers and ratings are certificated as required by the STCW Convention; YES

1.5 Confirming that any new equipment has been properly approved before installation and that no changes have YES
been made such as would affect the validity of the certificate;

1.6 Confirming that a record has been kept in the period since the last survey to the satisfaction of the NO
Administration and as required by the Radio Regulations (SOLAS 74/88 reg.IV/17);

1.7 Checking documentary evidence that the actual capacity of the battery has been proved in port within the last YES
12 months (SOLAS 74/88 reg.IV/13);

2. For the radio installations, including those used in life-saving appliances, the check that documentation, etc., has been placed on
board should consist of:

2.1 Valid Radio Station License by Flag Administration (ITU RR Art. 24) (Copy to be attached) YES

2.2 Radio Operator’s Certificates of Competence by Flag Administration (SOLAS 74/88 reg. IV/16 and ITU RR YES
Art. 56) (Copy to be attached);

Name: SHERIF ABDELMOHSEN ABDEL HAMID GMDSS CERT Valid Until:

No: GOC, 1ST GOC, 1ST , 2nd ,3rd Class of certificate1

Name: MOHAMED AHMED FAHIM GMDSS CERT Valid Until:

No: GOC, 2nd GOC, 1ST , 2nd ,3rd Class of certificate1

Name: GMDSS CERT Valid Until:

No: GOC, 1ST , 2nd ,3rd Class of certificate1

Name: GMDSS CERT Valid Until:

No: GOC, 1ST , 2nd ,3rd Class of certificate1

1
DELETE AS APPROPRIATE

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2.3 Radio Record (log) available on board SOLAS 74/88 reg.IV/17 and ITU RR App.11); YES

2.4 Are up-to-date editions of ITU documents (ITU RR App 11) on board

2.4.1. List of Coast Stations (List IV)

2.4.2. List of Ship Stations (List V)

2.4.3. List of Call Signs and Numerical Identities of Stations Used by the Maritime Mobile and Maritime

2.4.4. Mobile-Satellite Services (List VII A)

2.4.5. Manual for Use by the Maritime Mobile and Maritime Mobile-Satellite Services

2.5 Are operating manuals for all equipment on board? YES

2.6 Are adequate information to enable the equipment to be properly maintained on board (Reg. IV/15.3)? NA

2.7 Are adequate spares and service manuals available, if at-sea maintenance is declared (Reg. IV/15.4)? NA

2.8 Are new equipment properly approved before installation? YES

2.9 Examined position, physical and electromagnetic protection and illumination of each radio installation YES

3. Methods of maintenance (Reg. IV/15) (at least one method for sea areas A1 and A2; at least two methods for sea areas A3 and A4)

Duplication of equipment
Y Shore-based maintenance
At sea maintenance

4. Radio Equipment

4.1 General Equipment(Reg. IV/7)

4.1.1 VHF receiver/transmitter, including Digital Selective Calling (DSC) (Reg. IV/7.1.1)
Type and Serial Number of the equipment: SAILOR RT 6222 A / S/N :1331550222
Power supply: 12 V DC
State where distress alert is initiated:
4.1.2 VHF DSC watch receiver (Reg. IV/7.1.2)
Type and Serial Number of the equipment: SAILOR RT 6222 A / S/N :1331550222

Power supply: 12 VDC

4.1.3 Ship’s search and rescue locating devices (Reg. IV/7.1.3):

4.1.3.1 Radar Search and Rescue Transponder (SART)

Type and Serial Number of the equipment: 2 SETS MCMURDO RT9-3 S/N:RT9/9539167& RT9/9640161

4.1.3.2 AIS Search and Rescue Transmitter (AIS-SART)

Type and Serial Number of the equipment: N/A

(at least one apparatus is to provided on each side of every passenger ship and of every cargo ship of 500 tons gross tonnage and
upwards and at least one aboard cargo ships of 300 to 500 tons gross tonnage
4.1.4 NAVTEX receiver (Reg. IV/7.1.4)
Type and Serial Number of the equipment: ALDEN AE-900 S/N:231424
Frequencies: 518/480
4.1.5 The required INMARSAT EGC receiver is provided (Reg. IV/7.1.5)
Type and Serial Number of the equipment: N/A
4.1.6 Satellite EPIRB (Reg. IV/7.1.6)
Type and Serial Number of the equipment: SAMYUNG SEP-500 S/N:3A01178
Where located: NAV BRIDGE TOP
Remote activation SAMYOUNG HRU SHR 500
4.1.7 Two way VHF Radiotelephone Apparatus (Reg. III/6.2.1)
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Type and Serial Number of the equipment: 2 SETS INTEL HT 644 \ S/N:JHU406725& :JHU406723

4.1.8 Automatic Identification System

Type and Serial Number of the equipment: SAAB R4 S/N :111003

4.1.9 Long Range Identification Tracking System

Type and Serial Number of the equipment: N/A

4.2 Radio equipment - Sea Areas A1 (Reg. IV/8)

4.2.1 VHF using DSC (Reg.IV/8.1.1)
Type and Serial Number of the equipment: SAILOR RT 6222 A / S/N :1331550222
4.2.2 EPIRB
Type and Serial Number of the equipment: SAMYUNG SEP-500 S/N:3A01178
Remote Control: HYDROSTATIC SAMYOUNG HRU SHR 500
If yes, where located: NAV BRIDGE TOP

4.2.3 MF using DSC (Reg. IV/8.1.3)

Type and Serial Number of the equipment: N/A

4.2.4 HF using DSC (Reg. 8.1.4)

Type and Serial Number of the equipment: N/A

4.2.5 VHF EPIRB (Reg.8.3.1)

Type and Serial Number of the equipment: N/A

4.2.6 INMARSAT ship earth station

Type and Serial Number of the equipment: N/A

4.3 Radio equipment - Sea Areas A1 + A2 (Reg. IV/9)

4.3.1 MF receiver/transmitter (including DSC) (Reg. IV/9.1.1)
Type and Serial Number of the equipment:
Power supply:
Remote control
If yes, where located:
4.3.2 MF DSC watch receiver (Reg. IV/9.1.2)
Type and Serial Number of the equipment:
4.3.3 Secondary means of alert (Reg. IV/9.1.3)
Equipment provided:
Type and Serial Number of the equipment:
Power supply:
Remote control
If yes, where located:

4.3.4 Distress alert transmission (Reg. IV/9.2)

Where from:
How:

4.3.5 General communications (Reg. IV/9.3)

Equipment provided:
Type and Serial Number of the equipment:
Power supply:
Part of equipment mentioned in 4.1:

4.4 Radio equipment - Sea Areas A1 + A2 + A3 (Reg. IV/10)

4.4.1 INMARSAT (Reg. IV/10.1)
4.4.1.1 INMARSAT ship earth station (Reg. IV/10.1.1)
Standard:
Type and Serial Number of the equipment:
Power supply:
Antenna placed:
External equipment:
Remote control:
4.4.1.2 MF receiver/Transmitter (Reg. IV/10.1.2)
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Type and Serial Number of the equipment:

Power supply:
Remote control:
If yes, where located:
4.4.1.3 MF DSC watch receiver (Reg. IV/10.1.3)
Type and Serial Number of the equipment:
4.4.1.4 Secondary means of alert (Reg. IV/10.1.4)
Equipment provided:
Type and Serial Number of the equipment:
Power supply:
Remote control
If yes, where located:

4.4.1.5 General communications (Reg. IV/10.2.4)

Equipment provided:
Type and Serial Number of the equipment:
Power supply:
Part of equipment mentioned in 10.1

4.4.1.6 Distress alert transmission (Reg. IV/10.3)

Where from:
How:

4.4.2 MF/HF (Reg. IV/10.2)

4.4.2.1 MF/HF receiver/transmitter (Reg. IV/10.2.1)
Type and Serial Number of the equipment:
Power supply:
Remote control:
If yes, where located:
4.4.2.2 MF/HF DSC watch receiver (Reg. IV/10.2.2)
Type and Serial Number of the equipment:
4.4.2.3 Secondary means of alert (Reg. IV/10.2.3)
Equipment provided:
Type and Serial Number of the equipment:
Power supply:
Remote control:
If yes, where located:
4.4.2.4 General communications (Reg. IV/10.2.4)
Equipment provided:
Type and Serial Number of the equipment:
Power supply:
Part of equipment mentioned in 10.1

4.4.2.5 Distress alert transmission (Reg. IV/10.3)

Where from:
How:

4.5 Radio equipment - Sea Areas A1 + A2 + A3 + A4 (Reg. IV/11)

4.5.1 MF/HF (Reg. IV/11.1)
4.5.2 MF/HF receiver/transmitter (Reg. IV/10.2.1)
Type and Serial Number of the equipment:
Power supply:
Remote control:
If yes, where located:
4.5.3 MF/HF DSC watch receiver (Reg. IV/10.2.2)
Type of equipment:
4.5.4 Secondary means alert (Reg. IV/10.2.3)
Equipment provided:
Type and Serial Number of the equipment:
Power supply:
Remote control:
If yes, where located:

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4.5.5 General communications (Reg. IV/10.2.4)

Equipment provided:
Type and Serial Number of the equipment:
Power supply:
Part of equipment mentioned in 10.1
4.5.6 Distress alert transmission (Reg. IV/10.3)
Where from:
How:
4.5..7 Exemption from VHF DSC has been granted (Reg. IV/11.2)
Authority letter reference Nº: _____________________________ Date:

5. For the radio installations, including those used in life-saving appliances, of cargo ships the examination of plans and designs should
consist of:

5.1 Confirming all SOLAS equipment complies with appropriate performance standards not inferior to those YES
adopted by IMO (SOLAS 74/88 reg.IV/14);

5.2 Examining the plans for the provision and positioning of the radio installation including sources of energy YES
and antennas (SOLAS 74/88 regs.II-1/43, IV/6 and 14);

5.3 Examining the plans for the provision and positioning of the radio life-saving appliances (SOLAS 74/88 YES
reg.III/6).

6. For the radio installations, including radio life-saving appliances, of cargo ships the survey for in service installations should consist
of:

6.1 Examining the position, physical and electromagnetic protection and illumination of each radio installation YES
(SOLAS 74/88 reg. IV/6);

6.2 Confirming the provision of equipment for the radio installation with due regard to the declared sea areas in YES
which the ship will trade and the declared means of maintaining availability of functional requirements
(SOLAS 74/88 regs.III/6, IV/7 to 11, 14 and 15);

6.3 Confirming the ability to initiate the transmission of ship-to-shore distress alerts by at least two separate and YES
independent means, each using a different radio communication service, from the position from which the
ship is normally navigated (SOLAS 74/88 regs.IV/4, 7 to 11);

6.4 Examining all antennas, including: YES

6.4.1. Visually checking all antennas, including INMARSAT antennas, and feeders for Satisfactory siting YES
and absence of defects (SOLAS 74/88 reg.IV/14);

6.4.2. Checking insulation and safety of all antennas; YES

6.5 Examining the reserve source of energy, including:

6.5.1. Checking there is sufficient capacity to operate the basic or duplicated equipment for 1 hour or 6 YES
hours, as appropriate (SOLAS 74/88 reg.IV/13);

6.5.2. And if the reserve source of energy is a battery: YES

6.5.2.1. Checking its sitting and installation (SOLAS 74/88 reg.IV/13); YES

6.5.2.2. Where appropriate, checking its condition by specific gravity measurement or voltage YES
measurement;

6.5.2.3. With the battery off charge, and the maximum required radio installation load connected to YES
the reserve source of energy, checking the battery voltage and discharge current;

6.5.2.4. Checking that the charger(s) are capable of re-charging the reserve battery within 10 hours YES
(SOLAS 74/88 reg.IV/13);

6.5.2.5. Checking that information of ship’s position is provided continuously and automatically to YES
all two-way communication equipment (SOLAS 74/88 reg.IV/18);

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6.6 Examining the VHF transceiver(s), including: YES

6.6.1. Checking for operation on channels 6, 13 and 16 (SOLAS 74/88 regs.IV/7 and 14); YES

6.6.2. Checking frequency tolerance, transmission line quality and radio frequency power output (SOLAS YES
74/88 reg.IV/14);

6.6.3. Checking for correct operation of all controls including priority of control units(SOLAS 74/88 YES
reg.IV/14);

6.6.4. Checking that the equipment operates from the main, emergency (if provided) and reserve sources of YES
energy (SOLAS 74/88 reg.IV/13);

6.6.5. Checking the operation of the VHF control unit(s) or portable VHF equipment provided for YES
navigational safety (SOLAS 74/88 reg.IV/6);

6.6.6. Checking for correct operation by on-air contact with a coast station or other ship; YES

6.7 Examining the VHF DSC controller and channel 70 DSC watch receiver, including: YES

6.7.1. Performing an off-air check confirming the correct Maritime Mobile Service Identity is programmed YES
in the equipment (SOLAS 74/88 reg.IV/14);

6.7.2. Checking for correct transmission by means of a routine or test call to a coast station, other ship, on YES
board duplicate equipment or special test equipment;

6.7.3. Checking for correct reception by means of a routine or test call from a coast station, other ship, on YES
board duplicate equipment or special test equipment;

6.7.4. Checking the audibility of the VHF/DSC alarm; YES

6.7.5. Checking that the equipment operates from the main, emergency (if provided) and reserve sources of YES
energy (SOLAS 74/88 reg.IV/13);

6.8 Examining the MF/HF radiotelephone equipment, including: NA

6.8.1. Checking that the equipment operates from the main, emergency (if provided) and reserve NA
sources of energy (SOLAS 74/88 reg.IV/13);

6.8.2. Checking the antenna tuning in all appropriate bands; NA

6.8.3. Checking the equipment is within frequency tolerance on all appropriate bands (SOLAS 74/88 NA
reg.IV/14);

6.8.4. Checking for correct operation by contact with a coast station and/or measuring transmission line NA
quality and radio frequency output;

6.8.5. Checking receiver performance by monitoring known stations on all appropriate bands; NA

6.8.6. If control units are provided outside the navigating bridge, checking the control unit on the bridge has NA
first priority for the purpose of initiating distress alerts (SOLAS 74/88 regs.IV/9, 10, 11 and 14);

6.9 Examining the HF radiotelex equipment, including: NA

6.9.1. Checking that the equipment operates from the main, emergency (if provided) and reserve sources of NA
energy (SOLAS 74/88 reg.IV/13);

6.9.2. Confirming that the correct selective calling number is programmed in the equipment; NA

6.9.3. Checking correct operation by inspection of recent hard copy or by a test with a coast radio station NA
(SOLAS 74/88 regs.IV/10 and 11);

6.10 Examining the MF/HF DSC controller(s), including: NA

6.10.1. Checking that the equipment operates from the main, emergency (if provided) and reserve sources of NA
energy (SOLAS 74/88 reg.IV/13);

6.10.2. Confirming that the correct Maritime Mobile Service Identity is programmed in the equipment; NA

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6.10.3. Checking the off-air self-test program; NA

6.10.4. Checking operation by means of a test call on MF and/or HF to a coast radio station if the rules of the NA
berth permit the use of MF/HF transmissions (SOLAS 74/88 regs.IV/9, 10 and 11);

6.10.5. Checking the audibility of the MF/HF DSC alarm; NA

6.11 Examining the MF/HF DSC watch receiver(s), including: NA

6.11.1. Confirming that only distress and safety DSC frequencies are being monitored (SOLAS 74/88 NA
regs.IV/9 to 12);

6.11.2. Checking that a continuous watch is being maintained whilst keying MF/HF radio transmitters NA
(SOLAS 74/88 reg.IV/12);

6.11.3. Checking for correct operation by means of a test call from a coast station or other ship; NA

6.12 Examining the radiotelephone distress frequency watch receiver (SOLAS 74/88 regs. IV/7 and 14), NA
including:

6.12.1. Checking the mute/demute function; NA

6.12.2. Checking receiver sensitivity against known stations; NA

6.12.3. Checking the audibility of the loudspeaker; NA

6.13 Examining the INMARSAT Ship Earth Station(s), including: NA

6.13.1. Checking that the equipment operates from the main, emergency (if provided) and reserve sources of NA
energy, and that where an uninterrupted supply of information from the ship’s navigational or other
equipment is required ensuring such information remains available in the event of failure of the
ship’s main or emergency source of electrical power (SOLAS 74/88 regs.IV/13 and 14);

6.13.2. Checking the distress function by means of an approved test procedure where possible (SOLAS NA
74/88 Regs. IV/10, 12 and 14);

6.13.3. Checking for correct operation by inspection of recent hard copy or by test call; NA

6.14 If appropriate, examining the NAVTEX equipment (SOLAS 74/88 regs.IV/7, 12 and 14), including: YES

6.14.1. Checking for correct operation by monitoring incoming messages or inspecting recent hard copy; YES

6.14.2. Running the self-test program if provided; YES

6.15 Examining the Enhanced Group Call equipment (SOLAS 74/88 regs.IV/7 and 14), including: NA

6.15.1. Checking for correct operation and area by monitoring incoming messages or by inspecting recent NA
hard copy;

6.15.2. Running the self-test program if provided; NA

6.16 If appropriate, examining the radio equipment for receipt of maritime safety information by HF NARROW NA
BAND DIRECT PRINT (SOLAS 74/88 regs.IV/7, 12 and 14) including:

6.16.1. Checking for correct operation by monitoring incoming messages or inspecting recent hard copy; NA

6.16.2. Running the self-test program if provided; NA

6.17 Examining the 406 MHz satellite EPIRB (SOLAS 74/88 regs.IV/7 and 14), including: YES

6.17.1. Checking position and mounting for float free operation; YES

6.17.2. Carrying out visual inspection for defects; YES

6.17.3. Carrying out the self-test routine; YES

6.17.4. Checking that the EPIRB ID is clearly marked on the outside of the equipment and, where possible, YES
decoding the EPIRB identity number confirming it is correct;
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6.17.5. Checking the battery expiry date; YES

6.17.6. If provided, checking the hydrostatic release and its expiry date; YES

6.17.7. Checking the emission on operational frequencies, coding and registration on the 406 MHz signal YES
without transmission of a distress call to the satellite;

6.17.8. Checking that the EPIRB has been subject to maintenance at intervals not exceeding five years at an YES
approved shore-based maintenance facility (SOLAS 74/00 reg.IV/15.9);

6.17.9. If possible, checking the emission on operational frequencies, coding and registration on the 121.5 YES
MHz homing signal without transmission of a distress call to the satellite;

6.18 Examining the INMARSAT 1.6 GHz satellite EPIRB (SOLAS 74/88 regs.IV/7 and 14); NA

6.19 Examining the VHF DSC EPIRB (SOLAS 74/88 regs.IV/8 and 14); NA

6.20 Examining the two-way VHF radiotelephone apparatus (SOLAS 74/88 reg.III/6), including: YES

6.20.1. Checking for correct operation on Channel 16 and one other by testing with another fixed or portable YES
VHF installation (SOLAS 74/88 reg. IV/14);

6.20.2. Checking the battery charging arrangements where re-chargeable batteries are used; YES

6.20.3. Checking the expiry date of primary batteries where used; YES

6.20.4. Where appropriate, checking any fixed installation provided in a survival craft; NA

6.21 Examining the radar transponder(s) (SOLAS 74/88 regs.III/6, IV/7 and 14), including: YES

6.21.1. Checking the position and mounting; YES

6.21.2. Monitoring response on ship’s 9 GHz radar; YES

6.21.3. Checking the battery expiry date: JUNE 2017_________ YES

6.22 Examining the test equipment and spares carried to ensure carriage is adequate in accordance with the sea YES
areas in which the ship trades and the declared options for maintaining availability of the functional
requirements (SOLAS 74/88 reg.IV/15).

6.23 Confirming that the Automatic Identification System (AIS) is operational YES

6.23.1. Confirming the Annual Test of the Automatic Identification System (AIS) has been carried out YES
(copy of the Automatic Identification System (AIS) Test Report to be attached)

6.24 Confirming that the Long Range Identification and Tracking System (LRIT) is operational NA

6.24.1. Confirming the Long Range Identification Tracking System (LRIT) Performance test has been NA
carried out (copy of the Long Range Identification and Tracking System (LRIT) Performance
Test Report to be attached)

6.25 Checking the provision for the search and rescue location devices:

6.25.1. Confirming that the Radar Search and Rescue Transponder (SART) is operational YES

6.25.2. Confirming that the AIS Search and Rescue Transmitter (AIS-SART) is operational NA

7. Exemption:

7.1 Has any Exemption been granted by Flag Administration previously to the actual Survey (Copy of this NA
exemption certificate to be attached)

7.2 Has been an Exemption Certificate requested? NA

7.2.1. Conditions fulfilled for requested Exemption Certificate:

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7.2.2. Requested Exemption:

8. Particulars Of Alterations, Renewals And Replacements Of Items Listed In The Record

Parts listed below have been modified, renewed or replaced and the relevant pages in the Record have been corrected accordingly and replaced;
copies of those corrected pages are also attached to this Report:
DESCRIPTION OF THE ITEM(S)

4.1.1 VHF DSC SAILOR RT 6222 A / S/N :1331550222

9. Surveyor Notes
For negative entries, major repairs and additional information, if any, describe in detail
1.6 NO record has been kept in the period since the last survey to the satisfaction of the Administration and as required by the Radio
Regulations

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This is to declare that the undersigned has examined and filled all the items of this report before it was signed

Port: ABO QIER Port: ABO QIER

Date: 26\02\2017 Date:

Surveyed by: MOSTAFA ABDEL MOHSEN Witnessed by:

Radio Surveyor: ATTIYA
Full Name, Signature and Radio Surveyor to PANAMA SHIPPING REGISTRAR, INC.
Surveyor Seal if any Full Name, Signature and Surveyor Seal / ID

I have endorsed the FULL TERM HSSC CARGO SHIP SAFETY RADIO CERFIFICATE as required by Reg. I/9 or
I/14 (h) (iii) or I / 14 ( c ) or I 14/ ( d ) or I/14(e) . (Delete as appropriate), as PERIODICAL Survey completed YES / NO/ NA
satisfactorily.
HSSC CSSR FULL TERM CERTIFICATE No.: ______________________________________________

I have issued an INTERIM HSSC CARGO SHIP SAFETY RADIO CERTIFICATE No__________________________ YES / NO/ NA

REASON FOR ISSUING THE INTERIM CERTIFICATE:

Satisfactory Completion of Renewal Survey YES / NO/ NA
Implementation of HSSC YES / NO/ NA
Vessel Change Flag YES / NO/ NA
Vessel Change Recognized Organization YES / NO/ NA
Vessel have been found with MAYOR deficiencies and the existing HSSC CSSR have to be withdrawn YES / NO/ NA
Vessel is a new-building YES / NO/ NA

I RECOMMEND
No FULL TERM HSSC CARGO SHIP SAFETY RADIO CERTIFICATE is to be issued before the RECTIFICATION OF THE
REMARKS are completed.

The issuance of a FULL TERM HSSC CARGO SHIP SAFETY RADIO CERTIFICATE valid for a period of not exceeding 5 years.

Not To ENDORSE THE HSSC CARGO SHIP SAFETY RADIO CERTIFICATE No: __________________________________
before the RECTIFICATION OF THE REMARKS are completed.

To ENDORSE THE HSSC CARGO SHIP SAFETY RADIO CERTIFICATE No: _____________________________________

Report issued at On the

Port and Country DD/MM/YY

Surveyor to PANAMA SHIPPING REGISTRAR, INC.

Name, Signature and Surveyor Seal

HSSC-CSSR-REP 11/11
REV.10