COMPANY NAME

STEVEDORE DAMAGE REPORT

(DAMAGE TO VESSEL ONLY)

TO: (Stevedore Company) Date and Time of Damage:

SODERHAMN STUVERI and HAMN AB 22 May 2017 / 0000H to 0945H

VESSEL: MARS

AGENTS: CHARTERERS:
HML SHIPPING AB BOX 5033 INDUSTRI SKOG
S - 826 05 SODERHAMN

CAUSE OF DAMAGE
The damage was caused by stevedore’s grab and forklift during cargo operations inside Cargo Hold No. 3

DESCRIPTION OF DAMAGE
1 heavy indentation made by grab 4’03’’x3’00’x0’05’’ on No.3 hold bottom (Fr.67); 2 Brackets in way of Fr.62 &
64 bent inwards and displaced from connections above hopper tank by the forklift. The hatch coaming in way of
Fr.69 dented (3’06”x 1’10’’x 0.4”) by grab during discharging operations. Photographic evidence provided to
Stevedore’s Rep. (Total 4 photographs).

YES NO TEMPORARY
REPAIR CARRIED OUT:

ESTIMATED COST FOR REPAIR:

STEVEDORE COMPANY COMMENTS: Confirm receipt of Damage Report. However, that does not confirm that
the damages were indeed caused during vessel’s stay at Berth 27A on 22 nd May 2017, nor does it prejudice any
rights and privileges of M/S SODERHAMN STUVERI and HAMN AB in any way.

WITNESS TO THE DAMAGE:

DATE: 22 May 1997 DATE: 22 May 1997

SIGNATURE: SIGNATURE:
TITLE: 2nd Officer TITLE: Bosun

I, the undersigned, hereby hold the Stevedore

company responsible for the damage(s) as The cause and extent of damage are correctly
described: stated:
DATE: 22 May 2017 DATE: 22 May 2017

Capt. Kurt O. Hammarstroem

SIGNATURE OF MASTER SIGNATURE OF STEVEDORE REPRESENTATIVE:

Extent of damage and liability accepted: Refer

comments provided above
DATE:22 May 2017
DISTRIBUTION:

ORIGINAL: AOS, Spore

COPIES: Frontline SIGNATURE OF STEVEDORE REPRESENTATIVE
Agent
Stevedore company
Ship’s file