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CONDITION SURVEY REPORT

By INTERNATIONAL REGISTER OF SHIPPING

_________________________________________
Vessel Name:

Date of Survey:
Place of Survey:
Survey Company:
Surveyor’s Name:
Assignment No.:

Form Condition Rev.1/19/2004 Page 1 of 35


1. SHIP’S PARTICULARS:
Name Vessel Type
Flag Gross Tons
Port of Registry Deadweight Tons
Place of Construction TEU / Passengers
Date of Construction Owners
Classification Society Operators

Ports of call last voyage


Ports of call current voyage
Cargoes carried last voyage
Cargoes carried current voyage
2. CERTIFICATES:
Are all statutory certificates, including annual surveys, up to date? Yes No
Are there any overdue Classification surveys according to the quarterly listing? Yes No
Advise date of last Special Survey Advise date of last Dry Docking Survey
ISSUED – DATE & PLACE DATE OF EXPIRY

Registry Certificate

SOLAS 1/8 Safety Equipment Certificate


1/12SA (iii)
SOLAS 1/9 Safety Radio Certificate
1/12 (A)(iv)
SOLAS 1/10 Safety Construction Certificate
1/12 (A) (11)
Load Line 16- International Loadline Certificate
g
MARPOL 5.1 IOPP Certificate
IMO Annex 5 Garbage Certificate
LIABILITY
Financial Responsibility Certificate
VII-2
CLC Civil Liability Certificate
2.1 ISM CERTIFICATES:
SOLAS (Chapter IX) ISSUED – DATE & PLACE LAST ANNUAL
ENDORSEMENT
Document of Compliance:
Issuing Organization

Company Name & Address

Vessel Type listed on Certificate

ISSUED DATE DATE OF EXPIRY


Safety Management Certificate:
Intermediate Endorsement

Issuing Organization

Form Condition Rev.1/19/2004 Page 2 of 35


3. CONSTRUCTION and CONDITION OF SHIP’S HULL:

Describe the type of hull, with details of bulkheads and framing:

List materials for construction of the hull and piping:

Is high tensile steel used in the construction of the hull? Yes No

If Yes, advise grade and location:

Is the vessel Ice strengthened? Yes No

Are cargo holds strengthened for heavy cargoes? Yes No

If Yes, list:

Condition of the external shell plating:

Condition of the main, forecastle and poop deck plating:

Condition of handrails, bulwarks, deck/accommodation & pilot ladders:

Condition of the Internal shell plating, bulkheads and frames:

Condition of watertight openings, ports, skylights and scuttles:

Condition of ventilators, sounding pipes and filling pipes:

Percentage (%) of hull and deck plating not coated:


Port shell plating Starboard shell plating Main deck Forecastle deck Poop deck

Estimate the average depth and frequency of pitting:


Shell plating Deck plating

Form Condition Rev.1/19/2004 Page 3 of 35


Depth
Frequency

Are there any sharp indents on the shell or deck plating? Yes No

Is there any buckling on the shell or deck plating? Yes No

If Yes, advise extent and location of damage:

Advise areas of localized corrosion:

Describe the overall hull condition:

Additional remarks:

4. HULL and MACHINERY MAINTENANCE:

Is the maintenance system up to date? Yes No

Is there a planned maintenance system (PMS) which records overhaul dates and records of completed work? Yes No

If No, describe maintenance procedures:

Are there sufficient spare parts? Yes No

What is the procedure for the acquisition of spare parts?

Form Condition Rev.1/19/2004 Page 4 of 35


5. BALLAST TANKS:

Does the vessel have a regular inspection program for the ballast tanks? Yes No

Do Classification records indicate ballast tanks have significant corrosion? Yes No

Condition of coating (Class Records)

Are segregated ballast tanks coated? Yes No

Are anodes fitted? Yes No

If anodes are fitted, what type?

MARPOL Are cargo tanks used for ballast? Yes No


(16)
Are they coated? Yes No

If so, what is the type of coating?

Are anodes fitted? If so, what type? Yes No

MARPOL Is there an approved Cargo/Ballast Tank manual on board? Yes No


13A
Additional remarks:

5.1 BALLAST TANKS (Cont’d.):


Ballast Tank No. _______________
Approximate percentage wastage of anodes:
Cleanliness:
Condition of paint coating:
Condition of steel work:
Condition of piping:
Condition of access ladders & spindles:
Any evidence of oil contamination? Yes No
Has any structure been doubled Yes No
Any distortion in primary structural members? Yes No
Any detached or damaged structure? Yes No
If so, list:

5.2 BALLAST TANKS (Cont’d.):


Ballast Tank No. _______________
Approximate percentage wastage of anodes:
Cleanliness:
Condition of paint coating:
Condition of steel work:
Condition of piping:
Condition of access ladders & spindles:
Any evidence of oil contamination? Yes No
Has any structure been doubled Yes No

Form Condition Rev.1/19/2004 Page 5 of 35


Any distortion in primary structural members? Yes No

Any detached or damaged structure? Yes No


If so, list:

5.3 BALLAST TANKS (Cont’d.):


Ballast Tank No. _______________
Approximate percentage wastage of anodes:
Cleanliness:
Condition of paint coating:
Condition of steel work:
Condition of piping:
Condition of access ladders & spindles:
Any evidence of oil contamination? Yes No
Has any structure been doubled Yes No
Any distortion in primary structural members? Yes No
Any detached or damaged structure? Yes No
If so, list:

5.4 BALLAST TANKS (Cont’d.):


Ballast Tank No. _______________
Approximate percentage wastage of anodes:
Cleanliness:
Condition of paint coating:
Condition of steel work:
Condition of piping:
Condition of access ladders & spindles:
Any evidence of oil contamination? Yes No
Has any structure been doubled Yes No
Any distortion in primary structural members? Yes No
Any detached or damaged structure? Yes No
If so, list:

6. CARGO HOLDS: (GENERAL and BULK CARRIERS)

Number of cargo holds:


Number of tween decks:

Is it apparent that the collision bulkhead is doubled? Yes No


Is it apparent that the collision bulkhead is leaking? Yes No

6.1 CARGO HOLDS: (Cont’d.)

Cargo Hold No. _____________


Are there any indications that the wing ballast tank plating has been renewed or doubled? Yes No

Condition of hold structural items:

Condition of the paint coating on hold structures:

Form Condition Rev.1/19/2004 Page 6 of 35


Is grooving found on shell or frames? Yes No

Are there any damaged or detached side shell frames or brackets? Yes No

Are there any sharp and deep indents in the tank top? Yes No

Is the bilge suction fitted with an efficient filter? Yes No

Is there a bilge alarm system fitted? Yes No

Are the sounding and air pipes protected from damage? Yes No

Are the sounding and air pipes free from damage? Yes No

Is the ventilation system operational? Yes No

Are access ladders and guardrails free from damage? Yes No

List defects found in this cargo hold:

Additional comments:

6.2 CARGO HOLDS: (Cont’d.)


Cargo Hold No. _____________

Are there any indications that the wing ballast tank plating has been renewed or doubled? Yes No

Condition of hold structural items:

Condition of the paint coating on hold structures:

Is grooving found on shell or frames? Yes No

Are there any damaged or detached side shell frames or brackets? Yes No

Are there any sharp and deep indents in the tank top? Yes No

Is the bilge suction fitted with an efficient filter? Yes No

Is there a bilge alarm system fitted? Yes No

Are sounding and air pipes protected from damage? Yes No

Are sounding and air pipes free from damage? Yes No

Is the ventilation system operational? Yes No

Are access ladders free from damage? Yes No

List defects found in this cargo hold:

Form Condition Rev.1/19/2004 Page 7 of 35


Additional comments:

6.3 CARGO HOLDS: (Cont’d.)

Cargo Hold No. _____________

Are there any indications that the wing ballast tank plating has been renewed or doubled? Yes No

Condition of hold structural items:

Condition of the paint coating on hold structures:

Is grooving found on shell or frames? Yes No

Are there any damaged or detached side shell frames or brackets? Yes No

Are there any sharp and deep indents in the tank top? Yes No

Is the bilge suction fitted with an efficient filter? Yes No


Is there a bilge alarm system fitted? Yes No

Are sounding and air pipes protected from damage? Yes No

Are sounding and air pipes free from damage? Yes No

Is the ventilation system operational? Yes No

Are access ladders free from damage? Yes No

List defects found in this cargo hold:

Additional comments:

6.4 CARGO HOLDS: (Cont’d.)


Cargo Hold No. _____________

Are there any indications that the wing ballast tank plating has been renewed or doubled? Yes No

Condition of hold structural items:

Condition of the paint coating on hold structures:

Is grooving found on shell or frames? Yes No

Are there any damaged or detached side shell frames or brackets? Yes No

Form Condition Rev.1/19/2004 Page 8 of 35


Are there any sharp and deep indents in the tank top? Yes No

Is the bilge suction fitted with an efficient filter? Yes No

Is there a bilge alarm system fitted? Yes No

Are sounding and air pipes protected from damage? Yes No

Are sounding and air pipes free from damage? Yes No

Is the ventilation system operational? Yes No

Are access ladders free from damage? Yes No

List defects found in this cargo hold:

Additional comments:

6.5 CARGO HOLDS: (Cont’d.)

Cargo Hold No. _____________

Are there any indications that the wing ballast tank plating has been renewed or doubled? Yes No

Condition of hold structural items:

Condition of the paint coating on hold structures:

Is grooving found on shell or frames? Yes No

Are there any damaged or detached side shell frames or brackets? Yes No

Are there any sharp and deep indents in the tank top? Yes No

Is the bilge suction fitted with an efficient filter? Yes No

Is there a bilge alarm system fitted? Yes No

Are sounding and air pipes protected from damage? Yes No

Are sounding and air pipes free from damage? Yes No

Is the ventilation system operational? Yes No

Are access ladders free from damage? Yes No

List defects found in this cargo hold:

Additional comments:

Form Condition Rev.1/19/2004 Page 9 of 35


7. REEFER HOLDS: (REEFER CARGO SHIPS)

Number of reefer spaces:

Number of tween decks:

Number of lockers:

7.1 REEFER HOLDS: (Cont’d.)


Reefer Space No. _____________

Is the insulation on the overheads, bulkheads and deck intact? Yes No

Is there any evidence of wet insulation? Yes No

Condition of deck and hatch gratings:

Condition of cooling fans and fan rooms:

Condition of air screens and ducting:

Condition of air refreshing system:

Condition of refrigerant plant:

Refrigerant type and quantity:

Are insulated plugs fitted at accesses? Yes No

Are leaks apparent in brine pipes or coolers? Yes No

Is there any evidence of scuppers or bilges not draining correctly? Yes No

Are probes and sensors fitted in cargo and fan room spaces? Yes No

Are temperature, airflow and humidity measurements properly recorded? Yes No

Date of last Ice test:

List defects found in this reefer hold:

Additional comments:

7.2 REEFER HOLDS: (Cont’d.)


Reefer Space No. _____________

Is the insulation on the overheads, bulkheads and deck intact? Yes No

Is there any evidence of wet insulation? Yes No

Condition of deck and hatch gratings:

Condition of cooling fans and fan rooms:

Condition of air screens and ducting:

Form Condition Rev.1/19/2004 Page 10 of 35


Condition of air refreshing system:

Condition of refrigerant plant:

Refrigerant type and quantity:

Are insulated plugs fitted at accesses? Yes No

Are leaks apparent in brine pipes or coolers? Yes No

Is there any evidence of scuppers or bilges not draining correctly? Yes No

Are probes and sensors fitted in cargo and fan room spaces? Yes No

Are temperature, airflow and humidity measurements properly recorded? Yes No

Date of last Ice test:

List defects found in this reefer hold:

Additional comments:

7.3 REEFER HOLDS: (Cont’d.)


Reefer Space No. _____________

Is the insulation on the overheads, bulkheads and deck intact? Yes No

Is there any evidence of wet insulation? Yes No

Condition of deck and hatch gratings:

Condition of cooling fans and fan rooms:

Condition of air screens and ducting:

Condition of air refreshing system:

Condition of refrigerant plant:

Refrigerant type and quantity:

Are insulated plugs fitted at accesses? Yes No

Are leaks apparent in brine pipes or coolers? Yes No

Is there any evidence of scuppers or bilges not draining correctly? Yes No

Are probes and sensors fitted in cargo and fan room spaces? Yes No

Are temperature, airflow and humidity measurements properly recorded? Yes No

Date of last Ice test:

List defects found in this reefer hold:

Form Condition Rev.1/19/2004 Page 11 of 35


Additional comments:

7.4 REEFER HOLDS: (Cont’d.)


Reefer Space No. _____________

Is the insulation on the overheads, bulkheads and deck intact? Yes No

Is there any evidence of wet insulation? Yes No

Condition of deck and hatch gratings:

Condition of cooling fans and fan rooms:

Condition of air screens and ducting:

Condition of air refreshing system:

Condition of refrigerant plant:

Refrigerant type and quantity:

Are insulated plugs fitted at accesses? Yes No

Are leaks apparent in brine pipes or coolers? Yes No

Is there any evidence of scuppers or bilges not draining correctly? Yes No

Are probes and sensors fitted in cargo and fan room spaces? Yes No

Are temperature, airflow and humidity measurements properly recorded? Yes No

Date of last Ice test:

List defects found in this reefer hold:

Additional comments:

8. CONTAINER HOLDS: (CONTAINER SHIPS)

Number of holds:

Number of hatches:

Number of tiers:

Type of container ship:

Form Condition Rev.1/19/2004 Page 12 of 35


Is the lashing manual Class approved? Yes No

Is there evidence of maintenance on the lashing equipment? Yes No

Are there sufficient quantities of lashing equipment onboard? Yes No

8.1 CONTAINER HOLDS: (Cont’d.)

Container Hold No. ______________

Condition of cell guides and pads:

Condition of lashing equipment:

Condition of vents and ducting:

Is there any evidence of scuppers or bilges not draining correctly? Yes No

Are columns & tier weight restrictions observed? Yes No

Are reefer electrical connections in proper order? Yes No

List defects:

Additional comments:

8.2 CONTAINER HOLDS: (Cont’d.)


Container Hold No. ______________

Condition of cell guides and pads:

Condition of lashing equipment:

Condition of vents and ducting:

Is there any evidence of scuppers or bilges not draining correctly? Yes No

Form Condition Rev.1/19/2004 Page 13 of 35


Are columns & tier weight restrictions observed? Yes No

Are reefer electrical connections in proper order? Yes No

List defects:

Additional comments:

8.3 CONTAINER HOLDS: (Cont’d.)

Container Hold No. ______________

Condition of cell guides and pads:

Condition of lashing equipment:

Condition of vents and ducting:

Is there any evidence of scuppers or bilges not draining correctly? Yes No

Are columns & tier weight restrictions observed? Yes No

Are reefer electrical connections in proper order? Yes No

List defects:

Additional comments:

8.4 CONTAINER HOLDS: (Cont’d.)


Container Hold No. ______________

Condition of cell guides and pads:

Form Condition Rev.1/19/2004 Page 14 of 35


Condition of lashing equipment:

Condition of vents and ducting:

Is there any evidence of scuppers or bilges not draining correctly? Yes No

Are columns & tier weight restrictions observed? Yes No

Are reefer electrical connections in proper order? Yes No

List defects:

Additional comments:

9. PASSENGER/RO-RO/OFFSHORE VESSELS:

Type of vessel:

Trading area:

Type of fire detection system:

Type of sprinkler and fire suppression system:

Is the watertight integrity of the stabilizer spaces intact? Yes No

Are the public rooms in satisfactory condition? Yes No

Are escape routes and safety instructions posted for passengers and crew? Yes No

Are the galley and food handling areas in satisfactory condition? Yes No

Condition of watertight doors:

Condition of fire-resisting doors:

Condition of bow visors/shell doors:

Condition of lashing equipment:

Condition of ramps and lifts:

Condition of tanks for cement, ballast, drill water, drill mud, etc.:

Form Condition Rev.1/19/2004 Page 15 of 35


Bollard pull, tow winch type and capacity:

Tow wire type, size & time in use:

Work wire type, size & time in use:

Is spare towing wire onboard? Yes No

Catheads and tugger winches type, size and number:

Condition of the rig chain, hydraulic pins and sharks jaws:

Is the crash bar in satisfactory condition? Yes No

What type of pumping system is installed?

10. OIL TANKERS, OBO’S and ORE OILERS:

Number of cargo tanks:

Describe tank arrangement and materials:

Describe pumping and piping arrangement:

Describe ventilation arrangement:

Describe ballast and cargo heating system:

10.1 INERT GAS SYSTEM:


SOLAS II 11 Is an Inert Gas System installed and a log kept of Inert Gas operations? Yes No
2/60
SOLAS II 2/62 Is the Inert Gas System fully operational, including alarms, trips and instrumentation? Yes No
16.1
SOLAS II Is an approved Inert Gas System manual on board? Yes No
2/62.21
SOLAS II 2/62 Are pressure and 02 content recorders and indicators working? Yes No
16.1
SOLAS II What is the 02 content of the delivered Inert Gas in line?
2.62.3.2
SOLAS II Are tanks being maintained at a positive pressure? Yes No

SOLAS II When was the last calibration of the fixed 02 analyzer?

SOLAS III Are fixed combustible gas indicators working and calibrated? Yes No
2/62.18
SOLAS II Liquid level in the p/v breaker is correct and visible? Yes No
2/62.14.1
SOLAS II Liquid level in water seal is correct and visible? Yes No
2/62.19.7
SOLAS II 2/62 Cargo tanks can be individually isolated from the Inert Gas main line? Yes No
11.2.1
SOLAS 2/62 Inert Gas Non return valve in working order? Yes No
2.2
SOLAS II 2.59 Are Inert Gas lines velocity vents, mast risers and vent stacks in satisfactory condition? Yes No

10.2 CRUDE OIL WASHING SYSTEM:


MARPOL 13 Is a crude oil washing installation fitted? Yes No
(6) & (8)
MARPOL 13B Is an approved COW operations and equipment manual onboard? Yes No
(5)
IMO COW Is COW to be carried out at this port? Yes No
Form Condition Rev.1/19/2004 Page 16 of 35
1,6.1
IMO COW If so, has the IMO crude oil washing checklist been completed? Yes No
111 10
IMO COW Was the COW system pressure tested prior to use? Yes No
111 4 & 10
IMO COW Is the person in charge of COW operations certified? Yes No
1,5, 2.
IMO COW Is a COW plan prepared and followed? Yes No
111 12
IMO COW Are the COW line pressure gauges working? Yes No
111 10
IMO COW Have 02 readings of tanks to be COW been checked by portable meter and found below 80%? Yes No
111 5 & 10
IMO COW Is the tank cleaning heater effectively isolated from the COW line? Yes No
1.4.1.6
IMO COW Are any hydrant-type connections to the COW system fitted? Yes No
1.4.1.4
If Yes, are they blanked or isolated?

MARPOL 13 Does the vessel’s COW comply with MARPOL requirements? Yes No
(2)
IMO COW
1.6.1
IMO COW 2.2 Are COW operation recorded and kept on board? Yes No
IV
10.3 PIPING ON DECK:
Advise date when the cargo piping was last pressure tested:

Advise date when the heating coils were last pressure tested:

Is the deck piping well coated and maintained? Yes No

Condition of the piping:

Condition of the pipe clips and supports:

Is there any temporary piping in use? Yes No

Are flexible cargo hoses certified? Yes No

Is cargo piping Earthed? Yes No

Are there any indications of flanged connections leaking? Yes No

If so, list:

Is there any loose oil in savealls? Yes No

Additional comments:

10.4 PUMP ROOM:


Number of cargo pumps: Yes No

Number of ballast pumps: Yes No

Number of stripping pumps: Yes No

Are the pumps in satisfactory working condition? Yes No

Is there any evidence of leaking pumps or piping? Yes No

Form Condition Rev.1/19/2004 Page 17 of 35


Are the pump room fans operational? Yes No

Are the Emergency Stops for the cargo pumps operational? Yes No

Is the escape access clear of obstacles? Yes No

Is the lighting satisfactory? Yes No

Are valves in working condition? Yes No

Condition of piping:

Condition of overboard discharges:

Additional comments:

10.5 CARGO TANKS:


Cargo Tank No. ________________

Are access ladders and guardrails free from damage? Yes No

Are spindles and valves connected and in satisfactory condition? Yes No

Are access trunks, hatches, ullage and butterworth openings in satisfactory condition? Yes No

Condition of coating on primary structure:

Condition of web frames and connecting brackets:

Condition of heating coils and material:

Condition of cargo, ballast and hydraulic piping:

Estimate the degree of pitting in the shell and bottom plating:

Are tank vents and flame arrestors in satisfactory condition? Yes No

List defects found in this cargo tank:

Additional comments:

10.6 CARGO TANKS:


Cargo Tank No. ________________

Are access ladders and guardrails free from damage? Yes No

Are spindles and valves connected and in satisfactory condition? Yes No

Are access trunks, hatches, ullage and butterworth openings in satisfactory condition? Yes No

Condition of coating on primary structure:

Condition of web frames and connecting brackets:

Form Condition Rev.1/19/2004 Page 18 of 35


Condition of heating coils and material:

Condition of cargo, ballast and hydraulic piping:

Estimate the degree of pitting in the shell and bottom plating:

Are tank vents and flame arrestors in satisfactory condition? Yes No

List defects found in this cargo tank:

Additional comments:

10.7 CARGO TANKS:


Cargo Tank No. ________________

Are access ladders and guardrails free from damage? Yes No

Are spindles and valves connected and in satisfactory condition? Yes No

Are access trunks, hatches, ullage and butterworth openings in satisfactory condition? Yes No

Condition of coating on primary structure:

Condition of web frames and connecting brackets:

Condition of heating coils and material:

Condition of cargo, ballast and hydraulic piping:

Estimate the degree of pitting in the shell and bottom plating:

Are tank vents and flame arrestors in satisfactory condition? Yes No


List defects found in this cargo tank:

Additional comments:

10.8 CARGO TANKS:

Cargo Tank No. ________________

Are access ladders and guardrails free from damage? Yes No

Are spindles and valves connected and in satisfactory condition? Yes No

Are access trunks, hatches, ullage and butterworth openings in satisfactory condition? Yes No

Condition of coating on primary structure:

Form Condition Rev.1/19/2004 Page 19 of 35


Condition of web frames and connecting brackets:

Condition of heating coils and material:

Condition of cargo, ballast and hydraulic piping:

Estimate the degree of pitting in the shell and bottom plating:

Are tank vents and flame arrestors in satisfactory condition? Yes No

List defects found in this cargo tank:

Additional comments:

11. CHEMICAL TANKERS:

Number of cargo tanks:

Certificate of Fitness issued by and expiration date:

Product data sheets? Yes No

Tank cleaning guide? Yes No

Cargo and coating compatibility guides? Yes No

Describe tank arrangement and materials:

MARPOL In the case of a chemical vessel carrying oil, does the vessel fully comply with the requirements of Yes No
Appendix 11, MARPOL as per section 8 of the IOPP supplement (Form B)?
Form B Sect.
8
BCH 1,6,3 SOLAS Certificate of Fitness? Yes No

BCH 1.5.4 Has the vessel a BCH-IBC code and does the (BCH-IBC) have an expiry date? _______________ Yes No

BCH 5A 3.1 Does the vessel have and approved P&A manual on board? Yes No

Latest edition ICS Tanker Safety Guide? Yes No

STCW II V2 Do the vessel Officers have Chemical endorsements? Yes No

STCW II Res. Do all vessel crew have regular (annual) medical checks and blood tests? Yes No
11
Do “key” personnel attend chemical training courses? Yes No

MARPOL Is the “Cargo Record Book” properly compiled? Yes No


Annex 11
MARPOL Can the vessel comply with “Closed Loading” policy? Yes No
Reg. 9
List defects found:

Additional comments:

Form Condition Rev.1/19/2004 Page 20 of 35


12. GAS CARRIERS (LPG/LNG):

Number of cargo tanks:

Certificate of Fitness issued by and expiration date:

What are the minimum cargo temperatures?

What are the maximum tank working pressures?

Void spaces atmosphere, type and humidity:

Type of cargo tank insulation installed:

Type of pipeline insulation:

Cargo conditioning/reliquefaction system:

Tank environmental controls:

Condition of cargo pumps:

Overflow control system:

Deck tanks:

Cargo hoses:

Cargo space ventilation air changes per hour:

Emergency shut-down system operating time and date tested:

Product data sheets? Yes No

Cargo Operations Manual onboard? Yes No

Latest edition ICS Tanker Safety Guide? Yes No

Describe tank arrangement and materials:

MARPOL Is the “Cargo Record Book” properly compiled? Yes No


Annex 11
List defects found:

Additional comments:

13. CARGO & BALLAST SYSTEM:

Is there sufficient technical information for safe and efficient handling of cargo, ballast and slops? Yes No

Are drawings, pipeline diagrams, etc. available in the cargo control room? Yes No

Form Condition Rev.1/19/2004 Page 21 of 35


Are cargo sheets sufficient to cover all cargoes carried? Yes No

Are “cargo handling” operations carried out as per agreed plan and monitored and recorded? Yes No

ISGOTT 6.4 Are cargo/ballast pumps all fully operational? Yes No

Are pump controls, alarms and trips working properly and test results recorded? Yes No

Are cargo/ballast pump gauges and tachometers in order? Yes No

Are stripping pump(s) fully operational? Yes No

Are stripping pump gauges, controls and indicators fully operational? Yes No

Are eductors and associated gauges/indicators fully operational? Yes No

Are self-priming/draining facilities & associated gauges/indicators fully working? Yes No

Are all cargo/ballast valves operating from designed position? Yes No

Are manifold back pressure gauges fitted and in satisfactory condition? Yes No

Are there any interconnections between cargo/SBT ballast system? Yes No

Are there any interconnections between cargo/bunker systems? Yes No

ISGOTT 7.6.3 Is the vessel operating under closed conditions? Yes No


7.6.13
Are closed sampling devices installed? Yes No

What type of closed gauging is fitted?

ISGOTT 6.2.3 Condition of P/V valves and flame screen:

What type of cargo venting system is fitted?

IMO COW Are tank high level alarms fitted? Yes No


14.4.4
CLASS Is a “Stability and Stress” calculation instrument installed for this vessel? Yes No
RULES
List defects found:

Additional comments:

14. HATCH COVERS & CLOSING DEVICES:

Number of hatch covers:

Type of hatch covers:

Type of closing arrangements:

Are access hatch doors, gaskets, dogs and plating in satisfactory condition? Yes No

Are air pipes and sounding pipes free from damage? Yes No

Are air pipe headers and sounding pipe caps in satisfactory condition? Yes No

14.1 CARGO HATCH COVERS: (Cont’d.)

Hatch No. _____________

Form Condition Rev.1/19/2004 Page 22 of 35


Are there any indications that the hatch cover is leaking? Yes No

Condition of hatch cover plating:

Condition of hatch cover beams:

Condition of hatch coaming plating:

Condition of the paint coating on hatch structures:

Are compression bars straight and free from distortion or damage? Yes No

Are cross joint wedges and quick acting cleats in satisfactory condition? Yes No

Is the hatch cover rubber packing in satisfactory condition and without damage? Yes No

Is the rubber packing permanently impressed by more that 10mm? Yes No

Have the hatch covers been rebuilt at any stage? Yes No

Are hatch coamings, support and tripping brackets in satisfactory condition? Yes No

Are drain channels and pipes clear and free of blockage? Yes No

List defects found for this hatch cover:

Additional comments:

14.2 CARGO HATCH COVERS: (Cont’d.)

Hatch No. _____________

Are there any indications that the hatch cover is leaking? Yes No

Condition of hatch cover plating:

Condition of hatch cover beams:

Condition of hatch coaming plating:

Condition of the paint coating on hatch structures:

Are compression bars straight and free from distortion or damage? Yes No

Are cross joint wedges and quick acting cleats in satisfactory condition? Yes No

Is the hatch cover rubber packing in satisfactory condition and without damage? Yes No

Is the rubber packing permanently impressed by more that 10mm? Yes No

Have the hatch covers been rebuilt at any stage? Yes No

Are hatch coamings, support and tripping brackets in satisfactory condition? Yes No

Are drain channels and pipes clear and free of blockage? Yes No

List defects found for this hatch cover:

Form Condition Rev.1/19/2004 Page 23 of 35


Additional comments:

14.3 CARGO HATCH COVERS: (Cont’d.)


Hatch No. _____________

Are there any indications that the hatch cover is leaking? Yes No

Condition of hatch cover plating:

Condition of hatch cover beams:

Condition of hatch coaming plating:

Condition of the paint coating on hatch structures:

Are compression bars straight and free from distortion or damage? Yes No

Are cross joint wedges and quick acting cleats in satisfactory condition? Yes No

Is the hatch cover rubber packing in satisfactory condition and without damage? Yes No

Is the rubber packing permanently impressed by more that 10mm? Yes No

Have the hatch covers been rebuilt at any stage? Yes No

Are hatch coamings, support and tripping brackets in satisfactory condition? Yes No

Are drain channels and pipes clear and free of blockage? Yes No

List defects found for this hatch cover:

Additional comments:

14.4 CARGO HATCH COVERS: (Cont’d.)


Hatch No. _____________

Are there any indications that the hatch cover is leaking? Yes No

Condition of hatch cover plating:

Condition of hatch cover beams:

Condition of hatch coaming plating:

Condition of the paint coating on hatch structures:

Are compression bars straight and free from distortion or damage? Yes No

Are cross joint wedges and quick acting cleats in satisfactory condition? Yes No

Form Condition Rev.1/19/2004 Page 24 of 35


Is the hatch cover rubber packing in satisfactory condition and without damage? Yes No

Is the rubber packing permanently impressed by more that 10mm? Yes No

Have the hatch covers been rebuilt at any stage? Yes No

Are hatch coamings, support and tripping brackets in satisfactory condition? Yes No

Are drain channels and pipes clear and free of blockage? Yes No

List defects found for this hatch cover:

Additional comments:

14.5 CARGO HATCH COVERS: (Cont’d.)


Hatch No. _____________

Are there any indications that the hatch cover is leaking? Yes No

Condition of hatch cover plating:

Condition of hatch cover beams:

Condition of hatch coaming plating:

Condition of the paint coating on hatch structures:

Are compression bars straight and free from distortion or damage? Yes No

Are cross joint wedges and quick acting cleats in satisfactory condition? Yes No

Is the hatch cover rubber packing in satisfactory condition and without damage? Yes No

Is the rubber packing permanently impressed by more that 10mm? Yes No

Have the hatch covers been rebuilt at any stage? Yes No

Are hatch coamings, support and tripping brackets in satisfactory condition? Yes No

Are drain channels and pipes clear and free of blockage? Yes No

List defects found for this hatch cover:

Additional comments:

15. SAFETY EQUIPMENT:

SOLAS III 1.9 Are lifeboats, lifeboat equipment, lowering system and associated items in good condition? Yes No

Form Condition Rev.1/19/2004 Page 25 of 35


Are lifeboats totally enclosed? Yes No

Are lifeboat davits, wires, blocks and cut outs free from apparent defects? Yes No

Are Lifeboat wire ropes certified? Yes No

Yes No
Lifeboat engine started with satisfactory results?
SOLAS 18.3.1 Are regular lifeboat drills held? Yes No
18.3.7
Have the lifeboats been lowered and waterborne within the last three months? Yes No

SOLAS 19.8 Are life rafts in date? Yes No

Advise date and port where life rafts were last Port: Date:
serviced:
SOLAS 38.6 Yes No
Are hydrostatic releases in good condition, correctly attached?
SOLAS 29 Are life raft painters attached permanently to vessel in correct way? Yes No

Yes No
Are life rafts correctly stowed in cradles?
SOLAS 7.1.3 Are lifebuoy/lights in good operation/condition and without damage? Yes No

Are “quick release” man overboard lifebuoys and release systems in good operational order? Yes No

Are self-activating smoke signals attached to quick release man overboard lifebuoys in good condition Yes No
and in date?
SOLAS 51.52 Are training and maintenance manuals for life saving appliances on board? Yes No

SOLAS 9.2 Are lifeboat & life raft launching instructions clearly displayed? Yes No

Are immersion suits and/or thermal protective aids provided for the entire crew? Yes No

Does each lifeboat have at least three immersion suits? Yes No

SOLAS 6.3 Are pyrotechnics, line-throwing apparatus in good condition and up to date? Yes No

SOLAS V 17 Is the gangway in good condition and properly rigged? Yes No


(A)
SOLAS V 17 Are pilot ladders in good condition? Yes No
(B)
SOLAS V 17 Are pilot hoist fitted and in good condition? Yes No

16. FIRE FIGHTING EQUIPMENT:

SOLAS II Advise what the fixed fire extinguishing systems are for the following areas:

Engine Room: Date tested:


Cargo Spaces: Date tested:
Pump Room: Date tested:
Additional fire zones/areas covered by the fixed fire detection, extinguishing and alarm systems:
SOLAS 2.13 Are fire alarms tested regularly? Date tested:
SOLAS 2/4 Is the emergency fire pump fully operational and found satisfactory? Yes No
4.3
All fireboxes complete with hose and nozzle and in good order? Yes No
3.2
Is the fire hose coupling compatible with the hydrant coupling? Yes No
Are fire hydrants, fire mains and pumps free from heavy corrosion and damage where visible? Yes No
Form Condition Rev.1/19/2004 Page 26 of 35
Do the isolating valves and hydrants move freely? Yes No
Are sealing washers in place on fire hydrants? Yes No
Does the fire main leak? Yes No
SOLAS 2/19 Is the ship/shore fire connection readily available and accessible? Yes No

SOLAS 2.1 Are portable fire extinguishers in apparent good order? Yes No

Are portable fire extinguishers positioned according to approved plan and service up-to-date? Yes No
SOLAS II 2/5 Does fixed gas extinguishing system appear in good order? Yes No
2.1
SOLAS II Does fixed deck foam system appear in good condition? Yes No
2/61
Foam type:

Are operating instructions for fixed system clearly posted? Yes No


SOLAS II Are appliances located in compliance with the fire plans? Yes No
2/20
Are inspection records and inventory lists kept up-to-date? Yes No

SOLAS II Are fireman’s outfits in good condition and breathing apparatus ready for immediate use? Yes No
2.17
Are the air bottles fully charged, periodically hydrotested and sufficient spare bottles available? Yes No

17. BRIDGE EQUIPMENT & PUBLICATIONS:

SOLAS V Magnetic Compass fitted? Yes No


12(d) ii
Magnetic compass deviation table posted and valid? Deviation Card Date: _______________ Yes No

STCW 1.10 Is standard compass error determined at least once per watch & recorded? Yes No
SOLAS V Gyro alarm fitted and tested daily? Yes No
12(d-e) BPG
A (4-4)
SOLAS V Number of Radars
12 (h, I, j, k, l) Are records of radar usage kept? Yes No
Radar plotting equipment fitted? Yes No
Is an ARPA fitted (for vessel’s > 10,000 GRT)? Yes No
Is an Echo sounder fitted? Yes No
Are Speed and distance indicators fitted? Yes No
SOLAS V Rudder angle, RPM, pitch and bow thruster indicators present & visible from the bridge wings? Yes No
12(m)
SOLAS V Rate of turn indicators installed? Yes No
12(n)
SOLAS V 12 Radio Direction Finder fitted? Yes No
(p-q)
SOLAS IV Is the Radio D.F. calibration table posted valid? Yes No
12 a vii
SOLAS IV Are regular check bearings taken to confirm radio D.F. table? Yes No
12 a vii
SOLAS IV Radio telephone auto alarm (2,182 kHz) fitted? Yes No
16(a & g)
SOLAS IV VHF Radios fitted? Yes No
6.3, 7.1
SATNAV fitted? Yes No
GPS fitted? Yes No
LORAN fitted? Yes No

Form Condition Rev.1/19/2004 Page 27 of 35


DECCA fitted? Yes No
Sextants and Chronometers in order? Yes No
Signal lamp (Aldis) in satisfactory order? Yes No
SOLAS V 20 Are charts corrected up to latest Notice to Mariners received? Yes No
STCW Are charts in use appropriate for the port? Yes No
Res.1.20
Is navigation and bridge organization manual available? Yes No

STCW 11/1.2 Does the Master issue standing orders? Yes No


STCW 11/1.8 Are duties of the watch-keeping officers clearly defined? Yes No
STCW 11/1.6 Is a “Passage Plan” available for the current voyage? Yes No
A Res. 1.25
STCW 11/1.6 Is the Passage Plan “Berth to Berth”? Yes No
A Res. 1.25
Prior to port entry, was position fixing carried out at sufficiently frequent intervals? Yes No
STCW During Pilotage, was position fixing carried out at sufficiently frequent intervals? Yes No
11/1.10 Is Radar parallel index used to monitor position of vessel? Yes No
STCW Res.5 Are latest radio navigational warnings and local area weather reports available on the bridge? Yes No
10
SOLAS 11 Are maneuvering characteristics displayed on bridge? Yes No
1.28.3
IMO Res. A
601
SOLAS V 19 Are auto/manual steering changeover procedures displayed? Yes No
SOLAS 19 2 Is emergency steering changeover procedure displayed? Yes No
(C)
17.1 PUBLICATIONS:
Are the correct Pilot Books onboard? Yes No
Guide to Port Entry? Yes No
Mariner’s Handbook Yes No
ICS Bridge Procedures Guide? Yes No
Code of Safe Working Practices for Merchant Seamen? Yes No
The Master’s Role in Collecting Evidence? Yes No
Guide to Planning &Conduct of Sea Passages? Yes No
Ship Routing? Yes No
Merchant Ship Search & Rescue Manual? Yes No
Inert Gas Systems? Yes No
Ship to Ship Transfer Guide? Yes No
Code of Safe Practice for Solid Bulk Cargoes? Yes No
Hazardous Cargo IMO Guide? Yes No
P&I Club Bulletins Yes No
P&I Club Rule Book Yes No
IMO Manual on Oil Pollution? Yes No
International Code of Signals? Yes No
World-Wide Chart Catalogue? Yes No

Nautical Almanacs? Yes No


Tide Tables, Light Lists and Radio Signal Lists? Yes No
18. RADIO EQUIPMENT:

SOLAS IV 6 Is the radio equipment fitted, reported to be in full working condition? Yes No

Form Condition Rev.1/19/2004 Page 28 of 35


ISGOTT Are the main transmitting aerials earthed? Yes No
4.11.2
STCW Is the list of radio signals the latest edition, corrected and up to date? Yes No
Res.5B8
STCW Res.5- Are operating instructions for emergency transmitter/auto key clearly displayed? Yes No
18 SOLAS IV
6.5
SOLAS IV Is emergency lifeboat transmitter regularly tested? Yes No
13J
SOLAS IV Are emergency batteries in good working condition? (24 Volts/SG 1220-1260) Yes No
10P Is the battery log regularly completed? Yes No
Is the vessel fitted with the following:
SATCOM? Yes No
GMDSS? Yes No
TELEX? Yes No
TELEFAX? Yes No
WEATHERFAX? Yes No
SOLAS 111 Are EPIRBS, if fitted, fully inspected and tested? Yes No
6.2.3 IV 14.2
SOLAS 111 Are there at least three survival craft two-way radiotelephone apparatus on board? Yes No
6.2.4
19. ENGINE ROOM:

SOLAS II Is the engine room workshop machinery in good condition with moving parts well guarded? Yes No
2/59.3
SOLAS II Does steering gear/steering gear compartment comply with the latest SOLAS requirement in respect of Yes No
15.2 handrails, gratings and non-slip surfaces?
I-29
Is compartment and steering gear free of hydraulic leaks? Yes No
SOLAS V Are emergency steering gear changeover procedures clearly displayed in steering gear space? Yes No
19-2 (A)
SOLAS V The emergency steering gear has been tested recently Yes No
19-2 (D)
SOLAS II-1 Is the emergency header tank fully charged
29.12.3 15.3
SOLAS V 12 Are there suitable arrangements to supply heading information to the emergency steering position? Yes No
(F)
15.4
SOLAS V 12 Is there a compass at emergency steering gear position? Yes No
(D-E-F) 15.5
SOLAS 11-1 Is the rudder angle indicator clearly visible at the emergency steering position? Yes No
29.11
SOLAS 11-1 Are communications with the bridge satisfactory Yes No
29.10
SOLAS 11-1 Is access to steering gear unobstructed Yes No
29.13.1.2
15.6
MARPOL Is engine room bilge oily-water separator control system in good working condition? Yes No
16.5
15.7
Test/ alarm record available? Yes No
ISGOTT Are the engine room bilges clean and free of oil? Yes No
2.13.4 15.8
SALAS II Are deadweight type soundings pipe cocks to double tanks in good working condition? Yes No
15.26 15.9
Is sufficient routine maintenance being carried out? Yes No

Form Condition Rev.1/19/2004 Page 29 of 35


Do any pump glands have unacceptable leaks? Yes No

Are there any other fuel oil, lube oil or water leaks? Yes No
Are there any exhaust leaks from main engine or generators? Yes No
Are there any water leaks from main engine or generators? Yes No
Advise number of generators used during normal ocean passage, report loading Yes No
Are there any generators, purifiers or compressors that are out of service? Yes No
Are piping systems seen generally without signs of leakage and temporary repairs? Yes No
Is the switchboard in apparent good order? Yes No
Are the engine room lighting levels adequate? Yes No
Have there been any alterations to the electrical systems? Yes No

If yes, do these appear satisfactory? Yes No


Is the Engine Room properly ventilated? Yes No
Are Engine Room plates secured? Yes No
Is the Engine Room littered with oily rags? Yes No
Do any potential fire hazards exist? Yes No
Is asbestos fitted in the engine room? Yes No
If yes, describe the condition of the asbestos:

Advise condition of water in main boilers observation tank:

Advise condition of boiler lagging and watch glass:

Advise of any recent boiler problems and daily water consumption:

SOLAS II 1- Is the engineer’s alarm operational? Yes No


38
SOALS II If UMS, is alarm fitted? Yes No
1.51
SOLAS 46.3 If UMS, are duty cycles clearly defined? Yes No
STCW 111/1 Are the engine room emergency stops/shut-offs operational and clearly marked? Yes No
MARPOL Date the Emergency generator was last tested:
16(1)
SOLAS II Are the starting and operating instructions for the Emergency generator clearly posted? Yes No
1/43.7
SOLAS II Condition of the emergency generator batteries satisfactory? Yes No
1/43
Examine engine room log book for anomalies during most recent voyages:

List briefly the main engine room equipment:

Additional comments:

20. POLLUTION PREVENTION:

Form Condition Rev.1/19/2004 Page 30 of 35


ISGOTT 13.1 Is there a contingency plan to limit pollution effects? Yes No
IOPP IT 5.1
Are suitable anti-pollution warning notices posted? Yes No
MARPOL Is there an approved ballast oil content monitor on board? Yes No
15(3) 9.1 (A)
(IV)
MARPOL Is there an approved oil content monitor manual on board? Yes No
15.3
MARPOL 13 Is there an approved CBT Manual on board? Yes No
(A)4
ISGOTT Are written procedure for cargo, ballast and bunker transfers posted/available? Yes No
5.3/5.5
ISGOTT Has cargo/ballast/cow plan been prepared for current operations and agreed between ship and shore? Yes No
5.3/5.5
ISGOTT Are pump room sea valves/overboard valves/bilge overboard valves suitably lashed, sealed, locked and Yes No
6.9.2 marked?
ISGOTT Is the vessel free of hull, bulkhead, pipeline or valve leakage liable to cause pollution or effect cargo Yes No
3.1.3 handling?
Does vessel have a pollution response plan? Yes No
ISGOTT Are scuppers plugged/tight during cargo operations? Yes No
6.9.3
ISGOTT Is visual condition of cargo/bunker pipelines and couplings satisfactory? Yes No
3.1.3 Are suitable spill containers and gratings under cargo manifold? Yes No
SOLAS 11 Is adequate deck coaming fitted in front of poop deck housing? Yes No
2/5.6.6 Are suitable spill containers around bunker/vents? Yes No
ISGOTT Are unused cargo/bunker line manifold connections blanked and fully bolted? Yes No
6.9.5
Are hydraulic lines and machinery free of leaks? Yes No
Is deck free of oil/oily material? Yes No

ISGOTT Are means readily available for dealing with small oil spill? Yes No
6.9.1
Is there any warning or safeguard against bilge overboard discharge being accidentally opened? Yes No

MARPOL Is Oil Record Book Part 1 machinery space operations completed and up-to-date? Yes No
16.5
MARPOL Is Oil Discharge Monitoring and Control System (ODME) working and routinely used? Yes No
16.5
Is the pump room bilge’s high level alarm fitted and working? Yes No
Can pump room bilge valves be operated from top/outside space? Yes No

MARPOL 1- Oil released from purifiers and bilges is collected in a sludge tank? Yes No
17 Sludge pump fully operational? Yes No
MARPOL 1- Vessel fitted with a continuous deck edge fish-plate that encloses the deck area from bow to stern? Yes No
17
Is vessel fitted with at least two (2) valves on each pump room sea chest? Yes No
Is there a system to monitor the integrity of the space between the valves fitted? Yes No

Are cargo system pressure gauges and transmitters tested annually with a record kept onboard? Yes No
Additional comments:

21. CREW SAFETY & MANAGEMENT:

Are the access, internal and external ladders & stairways safe? Yes No

Form Condition Rev.1/19/2004 Page 31 of 35


Are there any internal or external floor areas which slippery or unsafe? Yes No
If yes, advise details:

Are Water Closets (WC) provided with flush water? Yes No


Are the Officer & Crew accommodations clean? Yes No
Is the galley & provision storeroom clean? Yes No
Are domestic cold stores clean? Yes No
Are doors in the cold storage rooms operational from both side & alarms working? Yes No
Are the crew wearing proper protective clothing and equipment? Yes No
Advise the procedures to train new crew members in safe working practices:

Advise the procedures to familiarize new crew members with the ship’s arrangements, equipment and operating procedures:

Advise the procedures to supervise crew members during manual work, when using lifting appliances and power tools:

21.1 CREW QUALIFICATIONS:


SOLAS V/13 Does manning comply with Minimum Manning certificate? Yes No
Are ship’s officers employees of the shipping company? Yes No
Are ship’s crew employees of the shipping company? Yes No
If no advise, who is the employer and what is the relationship is with the shipping company:

Can the officers and crew converse in a common language? Yes No

Does this ship appear to be operated in a safe and proper manner by the crew? Yes No

Certificates Date signed Sailed this ship Sailed with this Proficient in Nationality
on this ship before company before English
MASTER Yes No Yes No Yes No

C/O Yes No Yes No Yes No

2/O Yes No Yes No Yes No

3/O Yes No Yes No Yes No

C/E Yes No Yes No Yes No

2/E Yes No Yes No Yes No

3/E Yes No Yes No Yes No

4/E Yes No Yes No Yes No

Form Condition Rev.1/19/2004 Page 32 of 35


BOSUN Yes No Yes No Yes No

PUMPMAN Yes No Yes No Yes No

OTHER Yes No Yes No Yes No

OTHER Yes No Yes No Yes No

Additional comments:

22. SHIPBOARD MANAGEMENT:

Does the company/operator’s superintendent regularly visit the vessel? Yes No

ISGOTT Are smoke rooms identified and smoking regulations posted? Yes No
4.8 TSG
Are regulations being adhered to? Yes No
STCW Are there sufficient crew on duty to handle cargo work, mooring, safety, etc.? Yes No
11/8
ISGOTT 6.1.2 Are external doors, portholes and windows kept closed in port? Yes No

Are Junior Officers capable of handling routine cargo operation? Yes No

Do Junior Officers fully understand cargo/vessel operation while on duty? Yes No

STCW 3.11 Are officers familiar with emergency equipment operations? Yes No

Are start up procedures displayed for operation of the fixed fire fighting equipment? Yes No
SOLAS 11.2 Are fire control plans exhibited within the accommodation? Yes No
REG. 20.1
SOLAS III Are such plans available externally in fireproof containers? Yes No
8-3
Is such a plan in English and the language of the majority of crew? Yes No

Are muster lists/emergency instructions conspicuously displayed? Yes No

In the case of multinational crews are these readily understood by all? Yes No

Is personnel protective equipment provided such as: Safety harness, Eye Protections, Boiler Suits, Yes No
etc.?
Is the equipment being worn? Yes No
SOLAS II 1/36 Are ear protectors provided and used? Yes No

Are they being worn as requested? Yes No

Is lighting adequate on deck and in enclosed spaces? Yes No

SOLAS 2/59.3 Are pump room(s) adequately ventilated? Yes No

Are safety harnesses hung up and in place? Yes No

Instrument for measuring hydrocarbon content in 02 deficient atmosphere (Tank scope)? Yes No

SOLAS 11-2 Are portable instruments calibrated and in good working order? Yes No
62.18
How often are portable instruments calibrated? Yes No

Form Condition Rev.1/19/2004 Page 33 of 35


ISGOTT 2.8.3 Is electrical welding equipment in good condition? Yes No

Are safety guidelines available for use with electric welding equipment? Yes No
Spare oxygen and acetylene bottles stowed apart in a well-ventilated position outside the Yes No
accommodation and engine room?
If yes, is the position clearly marked? Yes No
Are proper procedures utilized for hot work? Yes No
Is there fixed piping from gas bottles to operating position? Yes No

Additional comments:

22.1 GENERAL SUMMARY:

Form Condition Rev.1/19/2004 Page 34 of 35


Date of survey : ________________________________
IRS
stamp

________(________________________________)_________
Surveyor to INTERNATIONAL REGISTER OF SHIPPING

Form Condition Rev.1/19/2004 Page 35 of 35

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