SUMMARY OF LOADING SURVEY

Client : PT. PELNI

Vessel : KM. SABUK NUSANTARA 63
Cargo : BIO SOLAR
Port : BIAK PORT

UNIT K/L Obsv K/L @15 °C Metric Tons

Delivery Order (DO) : 20,000 19,778 16,605

Ship Received : 20,027 19,804 16,627

Difference : 27 26 22

Or : 0.13 0.13 0.13

Gross O.B.Q : : ………………… ………………… …………………

Gross R.O.B : : ………………… ………………… …………………

PT. SUCOFINDO (Persero)

Name :

Signature : ……………….………
REPORT OF LOADING SURVEY
Client : PT. PELNI
Vessel : KM. SABUK NUSANTARA 63
Cargo : BIO SOLAR
Port : BIAK PORT

This is to report that above cargo has been surveyed on behalf of KM. Sabuk Nusantara 63 in conjunction
for Bunker Survey for Ship owned and operated By PT. Pelni.

Loading survey has been carried out at 09:50 hrs on Mar 7th, 2020 whilst ship berthed at port of Biak
upon completion of bunkering. Bunker quantity has been calculated and the result as follow :

1 Delivery Order (Flow Meter)

20,000 KL

2 Ship's Quantity Before Loading

1 KL

3 Ship's Quantity After Loading

20,028 KL

4 Ship's Quantity Received

20,027 KL

This Report refers to Loading Survey only and does not certify ony other matters. It reflects our findings at
time and place of inspection only and it is issued without prejudice.

Biak , Mar 7th, 2020

PT SUPERINTENDING COMPANY OF INDONESIA

as Independent Surveyor

Page 2 of 9
 BERITA ACARA LOADING SURVEY

Client PT. PELNI Cargo : BIO SOLAR

Vessel KM. SABUK NUSANTARA 63 Port : BIAK PORT

Pada hari ini Sabtu Tanggal 7 Mar 2020 jam 09:50 WIT telah dilakukan pengukuran dan

perhitungan BBM diatas kapal KM. SABUK NUSANTARA 63 oleh tim surveyor beserta pihak kapal

dan terminal dengan hasil sebagai berikut :

K/L OBS K/L @ 15 C Metric Tons

B/L Figure /DO 20,000 19,778 16,605

Vessel's Figure 20,027 19,804 16,627
Difference 27 26 22
Or % 0.13 0.13 0.13

REMARKS :

Demikian Berita acara ini kami buat untuk dipergunakan sebagaimana mestinya

Terminal Representative Chief Engginer/master PT. SUCOFINDO (Persero)

Name : …………………… Name : ……………………… Name : ………………………..

Signature : ……………… Signature : ….……………... Signature : ….……………...

 TIME LOG FOR LOADING OPERATION
(TRUCK TO SHIP'S)

Client : PT. PELNI

Vessel : KM. SABUK NUSANTARA 63
Cargo : BIO SOLAR
Port : BIAK PORT

DESCRIPTION TIME DATE

Vessel Arrived 17:35 6/3/2020

Pilot On Board - -
Vessel all fast 09:50 7/3/2020
Key Meeting 09:51 7/3/2020
Surveyor On Board 09:52 7/3/2020
Valve Sealed 09:54 7/3/2020
Tank Inspection and Measurement - @ Ship's 09:56 7/3/2020
Meter Inspection and Verification - @ Terminal 09.58 7/3/2020
Hoses Connected 11.10 7/3/2020
Loading Commenced 11.15 7/3/2020
Loading Completed 12.38 7/3/2020
Hoses Disconnected 12:42 7/3/2020
Visual Inspection and Sampling - 7/3/2020
Tank Inspection and Measurement - @ Ship's 17:18 7/3/2020
Meter Inspection and Verification - @ Terminal 17:20 7/3/2020
Document on Board 18:10 7/3/2020
Inspector Left Vessel 18:40 7/3/2020
Ship's Leave Terminal 7:00 15/2/2020
………………………………………………….
………………………………………………….

Remarks:

Terminal Representative Vessel Representative PT. SUCOFINDO (Persero)

Name : …………………… Name : ……………………… Name :

Signature : ……………… Signature : ….……………... Signature : ….……………...

 VESSEL MEASUREMENT FOR LOADING
OPERATION
Client : PT. PELNI Cargo : BIO SOLAR
Vessel : KM. SABUK NUSANTARA 63 Port : BIAK PORT

BEFORE RECEIVING
Density : 0.8450 Time / Date : 09:49 / 07/03/2020
Draft : Fwd : 1.6 Aft : 2.8 Trim : 1.20 Sea Condition
Sounding Gross obs. Density Temp. VCF Gross Std. WCF Gross Std.
Tank No. Vol. at 15 °C Vol. Wight
mm K/L Kg/L °C Table 54 K/L @15°C Table 57 M/T
1P 85 0.6375 0.8542 29 0.988884 1 0.8396 1
1S 95 0.859 0.8542 29 0.988884 1 0.8396 1

Total 1 Total Gross Std. Volume (K/L @15°C ) : 1

* Reported / Determined by : WCF Table 56 0.8531

Weight of GSV (MT) : 1

AFTER RECEIVING
Density : 0.8450 Time / Date : 12:40 /07/03/2020
Draft : Fwd : 1.6 Aft : 2.8 Trim : 1.2 Sea Condition
Sounding Gross obs. Density Temp. VCF Gross Std. WCF Gross Std.
Tank No. Vol. at 15 °C Vol. Wight
mm K/L Kg/L °C Table 54 K/L @15°C Table 57 M/T
1P 320 9647 0.8542 29 0.988884 9,540 0.8396 8,010
1S 336 10381 0.8542 29 0.988884 10,266 0.8396 8,619

Total 20,028 Total Gross Std. Volume (K/L @15°C ) : 19,805

* Reported / Determined by : WCF Table 56 : 0.8531
Weight of GSV (MT) : 16,629
TOTAL RECEIVED
Gross Std. Volume GSV @ 15 °C Metric Tons
20,027 19,804 16,627
Terminal Representative Vessel Representative PT. SUCOFINDO (Persero)

Name : Name : Name :

Signature : ……………… Signature : ….……………... Signature : ….……………...

 SAMPLE REPORT LOADING
(SHORE TO SHIP'S)

Client PT. PELNI Cargo : BIO SOLAR

Vessel KM. SABUK NUSANTARA 63 Port : BIAK PORT

With Inspection
AAASQ WWE

SAMPLE DESCRIPTION SAMPLE CONTAINER SAMPLE INFORMATION

B D A C U M L R
E U F O P I O U
F R T SOURCES QUANTITY SEAL NO. M P D W N DATE TIME DISTRIBUTION
O I E P E D E N
R N R O R L R I
E G S E N
I G
T
E

1X1L X

REMARKS :

The above samples will be retained for 3 months unless written instructions to the contrary received.
The samples covered by this receipt are left in your custody in accordance with the instructions received from our clients and/or your request.
We draw your attention to the fact that these samples are transported, storage and disposed of in a safe and legal manner is your responsibility. SUCOFINDO cannot be held
responsible.
Please refer to the relevant MSDS ( Material Safety Data Sheets ) which the procedure or owner of the product must make available to you and any other appropriates
safety, transportation, storage, disposal, composition and labeling information.
You may however elect to return the above samples to SUCOFINDO for disposal or package and dispatch at your account who will act upon receipt of your written orders.
Your signature indicates that you have read and understood this notice. If you have any questions, please call SUCOFINDO.

Terminal Representative Vessel Representative PT. SUCOFINDO (Persero)

Name : …………………… Name : ……………………… Name :

Signature : ……………… Signature : ….……………... Signature : ….……………...

 VALVE SEAL REPORT

Client : PT. PELNI

Vessel : KM. SABUK NUSANTARA 63
Cargo : BIO SOLAR
Port : BIAK PORT

Before / After Loading / Unloading / Transfer

We hereby report that on loading/discharge of the above mentioned cargo we have sealed the following :

NO Seal No Location Condition / Remark

1 VIII - 0275266-67 Truck Baik

2 VIII - 0275290-91, VII - 0275292-93 Truck Baik

3 VIII - 0275294-95 Truck Baik

Date was taken at _______________ hrs on date _________________________

Terminal Representative Vessel Representative PT. SUCOFINDO (Persero)

Name : …………………… Name : ……………………… Name :

Signature : ……………… Signature : ….……………... Signature : ….……………...

 SAMPLE RECEIPT

Client : PT. PELNI

Vessel : KM. SABUK NUSANTARA 63
Cargo : BIO SOLAR
Port : BIAK PORT

To: PT. PELNI

At the Installation of : PT. PERTAMINA on MAR 7TH, 2020

Please accept the following samples :

SAMPLE SOURCE QUANTITY SEAL NO.

TRUCK TANK 1X1L SCI

Representing a cargo of : HSD loading from : Biak Port

at (time) : 09:50 hrs on (date) : Mar 7th, 2020

The above samples will be retained for 3 months unless written instructions to the contrary received.
The samples covered by this receipt are left in your custody in accordance with the instructions received from our clients and/or your
request.
We draw your attention to the fact that these samples are transported, storage and disposed of in a safe and legal manner is your
responsibility. SUCOFINDO cannot be held responsible.
Please refer to the relevant MSDS ( Material Safety Data Sheets ) which the procedure or owner of the product must make available to
you and any other appropriates safety, transportation, storage, disposal, composition and labeling information.
You may however elect to return the above samples to SUCOFINDO for disposal or package and dispatch at your account who will act upon
receipt of your written orders.
Your signature indicates that you have read and understood this notice. If you have any questions, please call SUCOFINDO

Terminal Representative Master/ Chief Enginering PT. SUCOFINDO (Persero)

Name : …………………… Name : ……………………… Name :

Signature : ……………… Signature : ….……………... Signature : ….……………...

ASTM T53_T54_T56_T57_T52.xls