CERTIFICATE OF SURVEY

(Merchant Shipping Act, 1958 - Section 27)

Issued the Cov€mment of India

Name and Official Number, ifthere has been any
Name of Ship Port of intended Registry
former Registry

Whether a Steam or
Whether Indian or foreign builr Motor Ship: how Where built When built Name and address ofbuilders,
Propelled.

Number ofDecks Meters

Stem "Len91h"

Stem "Breadth"

Material / Description "Moulded depth

Amidships"

Number ofBulkheads

PARTICULARS OF TONNAGE

The Tonnage ofthis ship in accordance with her lntemational Tonnage Certificate (1969)/ lndian Tonnage Certificate (1987)* are :-

GROSS TONNAGE

NIT TONNACE

A detailed summary ofthe tonnage for the ship are shown in the Annex to lntemational Tonnage Certificate (1969) / Indian Tonnage
certificate ( 1987)+

The number ofseamen and tices for whom accommodation is certified Incl. Master

I, the undersigned SLrrveyor appointed under Section 27 ofth e Merchanl Shipping Act, 1958 having Surveyed the above
named
ship hereby certify that the aboye particulars are true, and that her name is marked on each ofher bows and her port
name and the of
Registry are properly marked on a conspicuous part ofher stem and scale of metres denoting her draught
are marked on each side of
her stem and ofher stem post as prescribed.

Dated at

Th is day of 20

S
SignalLetters (ifany)

* Delete as appropriate
Registry Form No. 16
 CERTIFIED EXTRACT OF PARTICULARS PROPELLING ENGINE Etc.AS SUPPLIED BY BUILDERS, OWNERS OR ENGINE, MAKERS

Reciprocating Engine Rotary

No. ol Whether
Number and
Power and
When Length of No. of
sets of Description ofEngines Indian or Name and Address of Makers Estimated SPeed
Made Diameter (in MM)
Engines Foreign Made Stroke in Cylinders of ShiP
of Cylinders in each
MM in each set
set

Model:

Engine No.:

No. of Particulars of Boilers

Shafts
Description

Nurnber

Loaded Pressure

Dated at

This day of Two Thousand

Surveyor

Signal Letters (ifany)