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GRIPSHOLM SHIPPING S.A.

SHIP MANAGEMENT

GUARANTEE CLAIM
M/V _____________________________
Yard no. : _____________

Date : __________________
Deck/Engine/Electrical Claim no. : __________________

Claimed part or unit :

______________________________________________________________________

Manufacturer :

______________________________________________________________________

Type Serial Number :

______________________________________________________________________

Description of defective part/unit :

___________________________________________________________
___________________________________________________________
___________________________________________________________

Date when trouble/damage noted :

___________________________________________________________

Working hours up to occurrence of trouble :


Kind/cause of trouble/damage :

_____________________________________________________

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________

Kind of repairs necessary :

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________

Temporary repairs carried out, when/where and by whom ?


__________________________________________________________________________________________
Required spare parts :

______________________________________________________________________
______________________________________________________________________

___________________________
Guarantee Yard Engineer

____________________________
Chief Engineer / Chief Officer

2 Copies - GRIPSHOLM SHIPPING S.A. ; 1 Copy - Ships File No. 20


FORM - 01

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Master

GRIP

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