DECLARATION ON COMPLETION OF ANNUAL INSPECTION FOR

AIS PERFORMANCE TEST

Vessel: SURFER 1855
MMSI Number: 372 312 000

1. This is to certify that the inspection for the AIS on board the captioned vessel have been completed
satisfactorily as follows.

1) Date of Completion of Inspection: 29 FEBRUARY 2024

2) Place of Inspection: PORT GENTIL, GABON
3) Name/Model of AIS: A200
4) Manufacturer: EM-TRAK

2. The items of performance test have been examined and recorded in accordance with the requirements
of SOLAS V 16 and found to be in compliance with IMO Resolution MSC. 74(69).

(Tick as appropriate)
X Initial Installation Check
X General Condition
X Verification of Input Data and Data Stored in AIS
X Ship’s Information up-date
X Verification of the AIS Functions

____________________________________
Technician – KEVIN PHILLIPSON

For Service Contact:

warren@kellymarine.co.za, eugene@kellymarine.co.za, arnold@kellymarine.co.za, gavin@kellymarine.co.za,