Document No D-24

PT. HABCO TRANS MARITIMA Tbk Issued Date 01-01-2023

Issued Status 1
DECK FORM & CHECKLIST
Revision 0
SHIP CONDITION
Arrival Berthing/ Unberthing Discharge Port
Departure Loading Port Anchor Area
Ship Name : Draft Forward :
Port Name : Draft After :
Voyage Number : Draft Middle :
Date : Trim :
Description EOSV/Arrival Finish With Engine Remarks
Marine Fuel Oil 180 MT MT
Marine Diesel Oil KL KL
ME Cylinder Oil Ltrs Ltrs
M/E LO System Ltrs Ltrs
A/E LO System Ltrs Ltrs
Tellus 68 Ltrs Ltrs
Tellus 32 Ltrs Ltrs
Corena S4 P 100 MT MT
Omala S2 220 MT MT
Fresh Water MT MT
Displacement MT MT
Total Cargo MT MT

ETA :

Time Date Description

Prepared by: Approved by:

(…..........................................) (…..........................................)
Chief Officer Master