[Nomor Form [OT
IN HIRE CERTIFICATE _{Tangeal Terbit 09th March 2022
|Tanggal Berlaku |09th March 2022
Due in Contract IRevisi jo
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Record No : 019/KSA-SMD/VII1/2022
This is Certify that,
Name of Vessel / Tugboat ‘TB. CAHAYA SHULTAN 1468
Name of Barge c
Has been duly delivery with status ON HIRE
From the Owner Messrs, PT. Pelayaran Karya Mahakam Jaya
To the Charterer Messrs PT. Pelayaran Kartika Samudra
Adijaya Agreement No
Descriptions
Place / Date & Time Samarinda, August 04 2022 14.35 LT
Fuel Oil 2+ Liters
Water + Liters,
Statement
Qn Hire certificate is made by PT. Pelavaran Kartika Samudra Adijaya (KSA) with addres JI, Jelawat,
‘Sidomulyo, Kec, Samarinda Tlir, Kota Samarinda, East Kalimantan Regency with Master and Chief
Engineer of the vessel (on behalf of Ship's Owner) carried out according to the actual and correct without
any adjustment and pressure from other side, and all data according our survey must be keep confidentially.
Other statements are during in contract the Vessel / Tugboat must be obey to user / charter regulation and
system.
For and on Behalf of The Owner For and on Behalf of The
Owner / Representative (Charterer / PT KSA
“ANDREAN RA.
‘General Manager Branch Manager