CERTIFICATE

of Inspection

Year : Month : Day : Type and name of ship/unit : Flag : IMO No. : Certificate No. :

2013 02 05 MT. GAS KOMODO INDONESIA 8910897 SS-130203.2.8

Place of service : Classification Society : Enclosed :

SURABAYA DNV 1

We hereby certify that the systems and equipment specified below have been inspected,serviced,refilled.
and tested according to requirement from IMO regulation,SOLAS and manufacturer.
The quantity of equipment and working code enclosed in Service Report back of this page.

X Immersion Suits

- Life Jackets

- Other

WIBRY YULUDFIYANTO
SURYA SEGARA STAMP AND SIGNATURE NAME IN PRINTED NAME
 CERTIFICATE
of Inspection

Year : Month : Day : Type and name of ship/unit : Flag : IMO No. : Certificate No. :

2013 02 05 MT. GAS KOMODO INDONESIA 8910897 SS-130203.2.8

Place of service : Classification Society : Enclosed :

SURABAYA DNV 1

We hereby certify that the systems and equipment specified below have been inspected,serviced,refilled.
and tested according to requirement from IMO regulation,SOLAS and manufacturer.
The quantity of equipment and working code enclosed in Service Report back of this page.

X Immersion Suits

- Life Jackets

- Other

APPROVED BY : PT. SURYA SEGARA

WIBRY YULUDFIYANTO
NAME IN PRINTED NAME
 safety marine
Workshop Labuan Bajo : Kampung Air Kemiri RT01/RW01 Gorontalo, Komodo, Kab. Manggarai Barat Nusa Tenggara Timur - Indonesia

APPROVAL : SAI GLOBAL ISO 9001:2015, 14001:2015, 45001:2018 | www.suryasegara.com

SURVEY AND TEST REPORT IMMERSION SUIT

Year : Month : Day : Type and Name of ship/unit : Flag : IMO Number : Sertificate No :

2013 02 05 MT. GAS KOMODO INDONESIA 8910897 SS-130203.2.8

Place of Service : Classification Society :
SURABAYA DNV
We hereby certify that the systems and equipment specified below have been inspected, serviced.
and tested according to requirement from IMO regulation, SOLAS and manufacturer.

Inflation Valve
Main Zipper &

Strorage Bag
Battery Exp.
Zipper Tab

PFD Light
Reflective

Leak Test
Cleaning
No. Brand. Type No. Serial Mfg. Date Notes

Whistle
& Hose

Repack
Repair

Other
Tape

Date
1 SCANDIA SC-AA D7538 05 - 2006 NO OK N/A OK NO YES RN 04 - 2014 OK YES OK - Good Condition
2 SCANDIA SC-AA D7536 05 - 2006 NO OK N/A OK NO YES OK 06 - 2011 OK YES OK - Good Condition
3 SCANDIA SC-AA D7537 05 - 2006 NO OK N/A OK NO YES OK 10 - 2013 OK YES OK - Good Condition
4 SCANDIA SC-AA D7510 05 - 2006 NO OK N/A OK NO YES OK 03 - 2014 OK YES OK - Good Condition
5 SCANDIA SC-AA D7533 05 - 2006 NO OK N/A OK NO YES OK 06 - 2011 OK YES OK - Good Condition
6 SCANDIA SC-AA D7541 05 - 2006 NO OK N/A OK NO YES OK 03 - 2014 OK YES OK - Good Condition
7 SCANDIA SC-AA D7512 05 - 2006 NO OK N/A OK NO YES OK 06 - 2011 OK YES OK - Good Condition
8 SCANDIA SC-AA D7476 05 - 2006 NO OK N/A OK NO YES OK 06 - 2011 OK YES OK - Good Condition
9 SCANDIA SC-AA D7511 05 - 2006 NO OK N/A OK NO YES OK 03 - 2014 OK YES OK - Good Condition
10 SCANDIA SC-AA D7531 05 - 2006 NO OK N/A OK NO YES RN 04 - 2014 OK YES OK - Good Condition