IMMOBILISATION OF MAIN ENGINE

I, Capt      
Master of m.v.      

do hereby request permission to immobilise my vessel’s main engine to carry out routine maintenance and
repairs:

from       hours on       to       hours on      

If instructed by the Harbour Master to mobilise my vessel, my vessel will require      
hours notice to prepare the main engines for manoeuvring.

I agree to observe all necessary safety precautions while my vessel is immobilised and shall closely monitor
the weather. If required, I shall arrange to put out extra mooring lines, lower anchor(s) if required, and/or
request for tug/pilot assistance.

     
Signature
Master of m.v.      

This form can either be e-mailed to: shipping@portofportland.com.au OR faxed to: +61 3 5521 7488

Office Use only

Permission granted: Yes No

     
Harbour Master
Port of Portland Pty Limited
Dated:      

Version dated 13 April 2011