CERTIFICATE

of Inspection

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

2009 05 30 LPG/C DEAUVILLE NASSAU 9113939 SS-090525.2.9

Place of service : Classification Society : Enclosed :

SURABAYA GERMANISCHER LLOYD 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.

- Immersion Suits

x 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. :

2009 05 30 LPG/C DEAUVILLE NASSAU 9113939 SS-090525.2.6

Place of service : Classification Society : Enclosed :

SURABAYA GERMANISCHER LLOYD 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.

- Immersion Suits

x Life Jackets

- Other

APPROVED BY : PT. SURYA SEGARA

SUBANDRIO
NAME IN PRINTED NAME
 Workshop Labuan Bajo : Kampung Air Kemiri RT01/RW01 Gorontalo, Komodo, Kab. Manggarai Barat Nusa Tenggara Timur - Indonesia
safety marine
APPROVAL : SAI GLOBAL ISO 9001:2015, 14001:2015, 45001:2018 | www.suryasegara.com

SURVEY AND TEST REPORT LIFE JACKET

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

Place of Service : Classification Society :

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.

Reflective Tape
CO2 Cylinder
Oral inflation

Date (mm/yy)
Light Battery
Press. Relief

Battery Exp.
Snap Hook
Bouyancy

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

Whistle
Manual

Inflator
Release

Repair
Cover

Valve

Valve
1 Crewsaver - 65113 2006 NO OK N/A OK NO NO YES N/A - OK YES OK - Good Condition
2 Crewsaver - 64715 2006 NO OK N/A OK NO NO YES N/A - OK YES OK - Good Condition
3 Crewsaver - 65511 2006 NO OK N/A OK NO NO YES N/A - OK YES OK - Good Condition
4 Crewsaver - 64206 2006 NO OK N/A OK NO NO YES N/A - OK YES OK - Good Condition
5 Crewsaver - 64828 2006 NO OK N/A OK NO NO YES N/A - OK YES OK - Good Condition
6 Crewsaver - 65004 2006 NO OK N/A OK NO NO YES N/A - OK YES OK - Good Condition
7 Harvey's - 71213 2002 NO OK OK OK NO NO YES OK 06/09 OK YES OK - Good Condition
Next Suggested Inspection Date : May 2010
Page : 1/1

WIBRY YULUDFIYANTO
SIGN AND STAMP