AUTOMATIC

IDENTIFICATION
SYSTEM (AIS) TEST
Annual Testing of Automatic Identification System (AIS) in accordance with IMORSN/Circ. 227 and resolution
MSC.74 (69), annex 3

PARTICULARS OF SHIP
Name of Ship Call Sign MMSI Number IMO Number Port of Registry
PYXIS ALFA 9V3776 563019900 9765457 SINGAPORE

Number Item Status

1. Installation Details
1.1 AIS Transponder type: {Insert Make and Model} FURUNO / FA-150 Yes
1.2 Type approval certificate Yes
1.3 Drawings provided (Antenna, AIS arrangement and block diagram) Yes
1.4 Main source of electrical power Yes
1.5 Emergency source of electrical power, Yes
1.6 Capacity to be verified if the AIS is connected to a battery Yes
1.7 Pilot plug near pilots operating position? Yes
1.8 120 VAC provided near pilot plug? (Panama and St. Lawrence requirement) NA
2. AIS programming – Static information
2.1 Name of Ship Yes
2.2 IMO number Yes
2.3 Maritime Mobile Service Identify (MMSI) Yes
2.4 Radio call sign Yes
2.5 Ship length Yes
2.6 Ship beam Yes
2.7 Type of ship Yes
2.8 Location of position fixing antenna on the ship. Yes
(aft of bow, port of stbd of centerline) Yes
3. AIS programming – Dynamic information
3.1 Ship position with accuracy and integrity status. Chart datum WGS84. (Source: GNSS) Yes
3.2 Time in UTC (Source: GNSS) Yes
3.3 Course over ground. (will fluctuate at dockside) (Source: GNSS) Yes
3.4 Speed over ground. (Zero at dockside) (Source: GNSS) Yes
3.5 Heading. (Source: Gyro) Yes
3.6 Navigational status. – Manual input Yes

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Form (17-01)
 Number Item Status
3.7 Rate of turn. – Where available NA
3.8 Angle of heel, pitch and roll. – Where available NA
4. AIS programming – Voyage related information
4.1 Ship draught Yes
4.2 Cargo type Yes
4.3 Destination and ETA Yes
4.4 Route plan (optional) NA
4.5 Short safety-related messages Yes
5. Performance test/Operating modes:
5.1 Check reception performance Yes
5.2 Confirm reception of won signal from other ships / VTS Yes
5.3 Polling by VTS. (Testing depends on shore infrastructure) Yes
6. Annual test using measuring instruments
6.1 Frequency measurements AIS ch.1 and 2, GMDSS ch. 70 Yes
6.2 Transmitting output, AIS ch.1 and 2, GMDSS ch. 70 Yes
6.3 Polling information ch. 70 Yes
6.4 Read data from AIS Yes
6.5 Send data to AIS Yes
6.6 Check AIS response to “virtual vessels” Yes

Remarks:

Surveyed by
Surveyor WONG CHEE KIEN Signature
Port SINGAPORE

Date 5/29/2022

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Form (17-01)