STATEMENT 0F FACT

SHIP'S NAME MT. AMANAH FLAG INDONESIA

GRT / NRT / DWT 1595 / 479 / 1440 LOA 70.6 M DRFT F. M A. M
SHIP'S OWNER PT. SAMUDERA SHIPPING SERVICE SHIP'S AGENT PT. SAMUDERA INDONESIA
ACTIVITY LOADING VOY 2328 DATE FEBRUARY 18, 2012
STEVEDORING CO PT. ASAHIMAS CHEMICAL TERMINAL PORT ANYER, ASAHIMAS JETY NO. 02
DATE TIME EVENTS
FEBRUARY 18, 2012 AT 11.00 HRS TIME ARRIVAL
AT 11.00 HRS NOTICE OF READINES TENDERED
AT _ HRS DROP ANCHORAGE
AT _ HRS UP ANCHORAGE
AT 11.44 HRS PILOT ON BOARD
AT 12.08 HRS FIRST LINE
AT 12.18 HRS ALL FAST
AT 12.50 HRS NOTICE OF READINES ACCEPTED/RECEIVED
AT 12.45 HRS HOSE CONNECTED
AT _ HRS CARGO SAMPLING
AT HRS TANK INSPECTION
AT _ HRS CARGO CALCULATION (INITIAL)
AT 13.00 HRS COMMENCED LOADING / DISCHARGING
AT HRS COMPLETED LOADING / DISCHARGING
AT HRS TANK INSPECTION
AT HRS CARGO CALCULATION (FINAL)
AT HRS HOSE DISCONNECTED

DESCRIPTION OF CARGO LOADING / DISCHARGING VINYL CHLORIDE MONOMER

QUANTITY AS PER B/L FIGURES MT
QUANTITY AS PER SHIP'S FIGURES MT

PT. ASHIMAS CHEMICAL DATE FEBRUARY 18, 2012

THE INDONESIACARGO TALLYCORPORATION

PT. MANPOWER PRESTIGE INDONESIA

 CHIEF OFFICERS STEVEDORES CHIEF TALLY CLERK

SHIP'S NAME MT. AMANAH FLAG INDONESIA

GRT / NRT / DWT 1595 / 479 / 1440 LOA 70.6 M DRFT F. M A. M
SHIP'S OWNER PT. SAMUDERA SHIPPING SERVICE SHIP'S AGENT PT. SAMUDERA INDONESIA
ACTIVITY LOADING VOY 2321 DATE DECEMBER 26, 2011
STEVEDORING CO PT. ASAHIMAS CHEMICAL TERMINAL PORT ANYER, ASAHIMAS JETY NO. 02

SHIP'S NAME MT. SINAR BUKOM FLAG INDONESIA

GRT / NRT / DWT 2025 / 986 / 3097 LOA 84.3 M DRFT F. M A. M
SHIP'S OWNER PT. SAMUDERA SHIPPING SERVICE SHIP'S AGENT PT. SAMUDERA INDONESIA
ACTIVITY LOADING VOY 60/11 DATE DECEMBER 26, 2011
STEVEDORING CO PT. ASAHIMAS CHEMICAL TERMINAL PORT ANYER, ASAHIMAS JETY NO. 02

SHIP'S NAME MT. GASCHEM ANTARCTIC FLAG LIBERIA

GRT / NRT / DWT 13879 / 4399 / 18940 LOA 155.64 M DRFT F. M A. M
SHIP'S OWNER SHIP'S AGENT PT. ISS MARINDO
ACTIVITY UNLOADING VOY 11/2011 D ATE JANUARY 01, 2012
STEVEDORING CO PT. ASAHIMAS CHEMICAL TERMINAL PORT ANYER, ASAHIMAS JETY NO. 01

SHIP'S NAME MT. CLIPPER HEBE FLAG NORWAY

GRT / NRT / DWT 13893 / 4388 / LOA 154.9 M DRFT F. M A. M
SHIP'S OWNER PR CLIPPER HEBE STAVENGER SHIP'S AGENT PT. SERASI SHIPPING INDONESIA
ACTIVITY UNLOADING VOY HEB 024 DATE JANUARY 02, 2012
STEVEDORING CO PT. ASAHIMAS CHEMICAL TERMINAL PORT ANYER, ASAHIMAS JETY NO. 01

SHIP'S NAME MT. SIGLOO HAV FLAG NORWAY

GRT / NRT / DWT 11191 / 3357 / 14520 LOA 153.05 M DRFT F. M A. M
SHIP'S OWNER SIGLOO GAS KS SHIP'S AGENT PT. SERASI SHIPPING SERVICE
ACTIVITY LOADING VOY HAV 025 D ATE JANUARY 26, 2012
STEVEDORING CO PT. ASAHIMAS CHEMICAL TERMINAL PORT ANYER, ASAHIMAS JETY NO. 01

SHIP'S NAME MT. LADY MATHILDE FLAG PANAMA

GRT / NRT / DWT 3435 / 1031 / 3856 LOA 97.69 M DRFT F. M A. M
SHIP'S OWNER MATHILDE SHIPPING SA SHIP'S AGENT PT. SERASI SHIPPING SERVICE
ACTIVITY LOADING VOY DATE
STEVEDORING CO PT. ASAHIMAS CHEMICAL TERMINAL PORT ANYER, ASAHIMAS JETY NO.

SHIP'S NAME MT. EPSILONGAS FLAG ANTIGUA & BARBUDA

GRT / NRT / DWT 5278 / 1583 / 6175 LOA 97.69 M DRFT F. M A. M
SHIP'S OWNER SHIP'S AGENT PT. TIRTA SAMUDERA CARAKA
ACTIVITY UNLOADING VOY DATE FEBRUARY 07, 2012
STEVEDORING CO PT. ASAHIMAS CHEMICAL TERMINAL PORT ANYER, ASAHIMAS JETY NO. 01

SHIP'S NAME MT. SHOECHI CHEMICHAL III FLAG INDONESIA

GRT / NRT / DWT 936 / 326 / 1498.25 LOA 97.69 M DRFT F. M A. M
SHIP'S OWNER PT. SUKSES OCEAN KHATULISTIWA SHIP'S AGENT PT. SAMUGARA
ACTIVITY LOADING VOY 02L/SCII/II/12 DATE FEBRUARY 07, 2012
STEVEDORING CO PT. ASAHIMAS CHEMICAL TERMINAL PORT ANYER, ASAHIMAS JETY NO. 02
DATE TIME EVENTS

SHIP'S NAME MT. CLIPPER HERMES FLAG NORWAY

GRT / NRT / DWT 13893 / 4383 / 18880 LOA 154.9 M DRFT F. M A. M
SHIP'S OWNER PT. SUKSES OCEAN KHATULISTIWA SHIP'S AGENT PT. SERASI SHIPPING SERVICE
ACTIVITY UNLOADING VOY DATE FEBRUARY 10, 2012
STEVEDORING CO PT. ASAHIMAS CHEMICAL TERMINAL PORT ANYER, ASAHIMAS JETY NO. 02
 DAFTAR ANAK BUAH KAPAL
CREW LIST
NAMA KAPAL AGENT
TB. HASNUR 03 PT. ADI BAHARI NUANSA
BENDERA PELABUHAN ASAL TANGGAL TIBA
INDONESIA PALEMBANG 220817
GRT PELABUHAN TUJUAN
272 GT SUNGAI PUTTING TGL BERANGKAT

BUKU MASA
NO NAMA JABATAN KEBANGSAAN IJAZAH
PELAUT BERLAKU
1 ABDUL HADI NAKHODA INDONESIA ANT - III C 072746 07072019
2 M. INDRA SRI HUDAYA MUALIM - I INDONESIA ANT - III C 067854 23072019

3 ANDRIANTO ROESTAM MUALIM - II INDONESIA ANT - III A 017238 28032017

4 YUSMAN ARDIANTO KKM INDONESIA ATT - II D 005266 09022018
5 SLAMET WINOTO MASINIS - II INDONESIA ATT - IV Y 084816 11042019

6 WAHYU TRI ROMADHONI MASINIS - III INDONESIA ATT - III A 036134 03052019
7 ADI SUPIAN JURU MUDI INDONESIA RATINGS X 085630 20102017
8 WIJANAKO FITRIYADI JURU MUDI INDONESIA RATINGS E 014532 19112018
9 CASPIN JURU MINYAK INDONESIA RATINGS B 081431 12072018
10 JOHAN FRANTO JURU MASAK INDONESIA RATINGS D 064821 18052018
JUMLAH ABK SEBANYAK 10 (SEPULUH ) ORANG TERMASUK NAHKODA

TB. HASNUR 03 PT. ADI BAHARI NUANSA

CAPT. ABDUL HADI MUHAMAD IKHLAS N

NAKHODA As Agent