T.V .. . . . . . . . . . . . . . . . . . . . .

WON. . . . . . . . . . . .

QUESTIONNAIRE
1) Voyage No.: ........
Launched on: ................... Last dry docking in: ....................... in .....................................
2) Last port of call: ......................................... sailed on: ......................... at:..............
Load port: ................................................... Date:.................................
Last Discharge port: ................................... Date:.................................
3) Arrival draft: Fore:............M Aft:..............M Trim:...........M List: Nil
Departure draft: Fore:..............M Aft:..............M Trim:...........M List: Nil
4) All tanks: ..............................................................................................
Nominated tanks: ................................................................................. Empty: Y / N
Non-nominated tanks: .......................................................................... Empty: Y / N
First tank: ..................... Last tank: ...................... Draining tank: .......................
5) Slops on board: Y / N Slop tanks: .................
6) Manifold No.: ............ P / S Cargo line No.: ………………………………..
Pipeline content: Y / N
All deck and bottom cargo line was drained thoroughly before initial gauge and final gauging?
SC valves: P / S OB valves: P / S

Cargo to be heated during loading: Y / N

7) Last 3 cargoes (name & per plan): .................................................................................................
Cleaning procedure at last voyage: COW / well-stripped / ...........................................................
Crude Oil Carried out in all tanks: .................................................................................................
8) Bunker report (arrival & departure)
Bunker consumption (sea, load port & anchorage) & Bunker on sailing; LEL: . . . . . .
9) Vessel Experience Factor
10) Ballast Report (arrival & departure, MT in each tank)
11) Agreed quantity to be loaded .......................................net bbls
[ ] Ship stop [ ] Shore stop
12) Stowage Plan & Ullage Table
13) MMC/ UTI Certificate
14) Computer & Printer Email: Y / N
15) Hourly ship/ shore figure comparison (. . . . . . . @ obs. temp.)
16) H2S testing after loading (before sampling)
17) Ship’s particulars
18) Ship maximum loading rate: ………………CBM/hr

CHIEF OFFICER

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Thanks for your cooperation