PT.

CAKRA BAHANA

FSO : Surya Putra Jaya Date : 11th MARCH 2016

PORT :Oyong Terminal - Camplong

ITEM COPIES REMARK

ORG DESCRIPTION Issued by
NO (NO) Date of issue
1 √ CERTIFICATE OF NATIONALITY / SURAT LAUT DITJEN PERLA 09-Jan-14

2 √ INTERNATIONAL TONNAGE CERTIFICATE (1969) / 23-Dec-13

SURAT UKUR INTERNASIONAL (1969) DITJEN PERLA

CARGO SHIP SAFETY EQUIPMENT CERTIFICATE /

3 √ SERTIFIKAT KESELAMATAN PERLENGKAPAN KAPAL 04-Feb-16
BARANG DITJEN PERLA

CARGO SHIP SAFETY CONSTRUCTION CERTIFICATE /

4 √ SERTIFIKAT KESELAMATAN KONSTRUKSI KAPAL 04-Feb-16
BARANG DITJEN PERLA

5 √ CARGO SHIP SAFETY RADIO CERTIFICATE / 04-Feb-16

SERTIFIKAT KESELAMATAN RADIO KAPAL BARANG DITJEN PERLA

6 √ SAFETY MANAGEMENT CERTIFICATE / SERTIFIKAT 11-Feb-16

MANAJEMEN KESELAMATAN DITJEN PERLA

7 √ DOCUMENT OF COMPLIANCE / DOKUMEN 29-Aug-14

PENYESUAIAN MANAJEMEN DITJEN PERLA
CERTIFICATE OF INSURANCE OR OTHER FINANCIAL
SECURITY IN RESPECT OF CIVIL LIABILITY FOR OIL
8. A √ POLLUTION DAMAGE / SERTIFIKAT DANA JAMINAN DITJEN PERLA 26-Jan-16
GANTI RUGI PENCEMARAN MINYAK
CERTIFICATE OF INSURANCE OR OTHER FINANCIAL
SECURITY IN RESPECT OF CIVIL LIABILITY FOR
8. B √ BUNKER OIL POLLUTION DAMAGE / SERTIFIKAT DANA DITJEN PERLA 26-Jan-16
JAMINAN GANTI RUGI PENCEMARAN MINYA BAHAN
BAKAR
North Of England P N
8. C √ CERTIFICATE OF ENTRY I 20-Feb-16
INTERNATIONAL OIL POLLUTION PREVENTION
9.A √ CERTIFICATE / SERTIFIKAT INTERNASIONAL DITJEN PERLA 16-Sep-14
PENCEGAHAN PENCEMARAN OLEH MINYAK
INTERNATIONAL AIR POLLUTION PREVENTION
9.B √ CERTIFICATE / SERTIFIKAT INTERNASIONAL DITJEN PERLA 16-Sep-14
PENCEGAHAN PENCEMARAN UDARA
INTERNATIONAL SEWAGE POLLUTION PREVENTION
9.C √ CERTIFICATE / SERTIFIKAT INTERNASIONAL DITJEN PERLA 16-Sep-14
PENCEGAHAN PENCEMARAN OLEH KOTORAN
STATEMENT OF COMPLIANCE OF PORT FACILITY /
10 √ PERNYATAAN PEMENUHAN KEAMANAN FASILITAS DITJEN PERLA 24-Nov-15
PELABUHAN

11 √ MINIMUM SAFE MANNING DOCUMENT / DOKUMEN DITJEN PERLA 22-Jan-15

KESELAMATAN PENGAWAKAN MINIMUM

12 √ SHIP STATION LICENSE / IZIN STASIUN RADIO KAPAL Ditjen Pos & 28-Jan-16
LAUT Inform.
 CERTIFICATE SANITATION CONTROL EXEMPTION
Port Health Office
13 √ CERTIFICATE / SERTIFIKAT BEBAS TINDAKAN SURABAYA 21-Nov-15
SANITASI KAPAL

CERTIFICATE OF WATER QUALITY AT PORT, AIRPORT,

Port Health Office
14.A √ AND GROUND - CROSSING FOR CONVEYANCE / SURABAYA 21-Nov-15
SERTIFIKAT QUALITAS AIR PELABUHAN, BANDARA, & POS LINTAS
BATAS DARAT(PLBD) UTK KEPERLUAN ALAT ANGKUT

SHIP'S MEDICAL CHEST CERTIFICATE / SERTIFIKAT Port Health Office

14.B √ SURABAYA 06-May-15
OBAT DAN ALAT KESEHATAN KAPAL
15 √ CERTIFICATE OF PARTICULAR CHANGE NKK 25-Oct-13
16 √ CERTIFICATE OF CLASSIFICATION NKK 01-May-14
17 √ CERTIFICATE OF INSTALATIONS REGISTRATION NKK 01-May-14

18 √ INTERNATIONAL LOAD LINE CERTIFICATE (1966) 04-Feb-16

INTERIM NKK
LIFTING APPLIANCES & ITEMS OF LOOSE GEAR
19 A √ BOOK NKK 06-Sep-05
CERTIFICATE OF TEST AND THROGH EXAMINATION
19 B √ OF CRANES OR HOISTS AND THEIR ACCESSORY 04-Feb-16
GEAR NKK
CERTIFICATE FOR LIFEBOAT TOTALLY ENCLOSED
20.A √ TYPE M 20-Apr-11

20.B √ CERTIFICATE FOR ENGINE FOR LIFEBOAT / RESCUE 13-Mar-11

BOAT NKK

21.A √ CERTIFICATE OF RE-INSPECTION INFLATABLE OF Surya Segara M. 11-Aug-15

LIFERAFT (SS-150803.1.1)

21.B √ CERTIFICATE OF RE-INSPECTION INFLATABLE OF Surya Segara M. 11-Aug-15

LIFERAFT (SS-150803.1.2)

21.C √ CERTIFICATE OF RE-INSPECTION INFLATABLE OF Surya Segara M. 28-Aug-15

LIFERAFT (SS-150803.1.3)

22 √ CERTIFICATE OF INSPECTION PORTABLE FIRE Surya Segara M. 20-Aug-15

EXTINGUISHER (SS-150803.2.1)

23 √ CERTIFICATE OF INSPECTION BREATHING Surya Segara M. 20-Aug-15

APPARATUS (SS-150803.2.3)

24 √ CERTIFICATE OF INSPECTION ESCAPE SETS (SS- Surya Segara M. 20-Aug-15

150803.2.4)

25 √ CERTIFICATE OF INSPECTION FIXED HALLON Surya Segara M. 20-Aug-15

SYSTEM (SS-150803.2.7)

26 √ CERTIFICATE OF INSPECTION FIXED FOAM SYSTEM Surya Segara M. 20-Aug-15

(SS-150803.2.12)
LETTER OF DESCRIPTION OF FOAM ANALYSIS (SS-
27 √ 140713.2.12) Surya Segara M. 25-Aug-15

28 √ BERITA ACARA REKOMENDASI PENGUNCIAN SHAFT DITJEN PERLA 13-Nov-15

PROPELLER
29 √ SURAT IZIN PERUSAHAAN ANGKUTAN LAUT (SIUPAL) DITJEN PERLA 01-Apr-04

30 √ C ONTINOUS S YPNOPSIS R ECORD (C S R) DITJEN PERLA 20-Feb-11

31 √ STATEMENT OF COMPLIANCE - ANTI FOULING NKK 31-Dec-12

CERTIFICATE
32 √ SHORE-BASE MAINTENANCE AGREEMENT JRC 17-Sep-14
33 √ PEMERIKSAAN SAFETY & FIRE CONTROL PLAN Ditjen Perla 02-Oct-14
34 √ BERITA ACARA PENGGANTIAN BENDERA KBRI S'pore 15-Sep-10
35 √ BERITA ACARA SERAH TERIMA SERTIFIKAT KAPAL 15-Sep-10
KBRI S'pore
36 √ BUKU PENGESAHAAN PENGGANTIAN NAKHODA Ditjen Perla
37 √ BUKU SIJIL Ditjen Perla

prepared By

Master FSO. Surya Putra Jaya

 F/SMSO/2/3-V1

PT. CAKRA BAHANA

CHANGE OF COMMAND

ITEM COPIES
ORIGINAL DESCRIPTION REMARK
NO (NO)
27. Garbage Management Log Book
28. Complete Set of Ship'Drawings and Plans
29. IOPP Certificate + Form B
30. Safety Management Certificate (SMC)
31. Document of Compliance (DOC) - Copy only
32. Quaterly Listing from Class & Survey status
33. Certificate of Ropes and Wires
34. Safety Manning Certificate
35. ISPS Certificate & Ship's Security Manual/Plans
36. Certificates of MMC / UTI Calibration
37. Certificate of Calibration of all Gas Meters
38. Following Class approved Manulas (1) Loading/
discharging (2) Damage Stability, (3) Gauging
Status of (4) ODME (5) Loadicator.
39. Last Port Clearance
40. Current Voyage File with Charter Party
41. Owner's/Charterer's Voyage Instructions
42. Current Cargo plan & cargo Manifest
43. Certificate of Fitness
44. Notice of Readiness
45. Hand-Over Notes
46. Oil Record Book (Part 1 & 2)

Heavy Oil Remaining Onboard ________________________ MT

Diesel Oil Remaining ________________________ MT
Fresh Water Remaining O/b ________________________ MT
Cash Remaining O/b US $ ____________________
All above-mention ship's documents and items have been received in good order and
condition as per remark.

Out-going Master __________________ In-coming Master _____________________

Distribution :
Original to Head Office
cc. Ship's file cc ; Out-going Master
REMARK
Date of exp
permanent

permanent

20-Jan-17

20-Jan-17

20-Jan-17

12-Feb-21

02-Sep-19

20-Feb-17

20-Feb-17

20-Feb-17

15-Sep-17

15-Sep-17

15-Sep-17

16-Nov-20

06-Feb-16

27-Jan-21
20-May-16

20-May-16

05-Nov-15

07-Jun-17
07-Jun-17

03-Jul-16

Jan 2021

10-Aug-16

10-Aug-16

27-Aug-16

19-Aug-16

19-Aug-16

19-Aug-16

19-Aug-16

19-Aug-16

24-Aug-16

12-May-16

16-Sep-19
-
-
-
-
-
SMSO/2/3-V1

REMARK
2 of 2
GENERAL INFORMATIONS

VESSEL NAME / PREVIOUS NAME :

IMO NUMBER / CALL SIGN :

PORT REGISTRY :

DIMENSTONS (LOAX LBP X B X D) METERS :

GRT / NRT :

MAXIMUM DRAFT (SUMMER) :

SUMMER DEADWEIGHT :
Type: BHP:
MAIN PROPULSION :

DATE OF INSPECTION :

LOCATION OF INSPECTION :

DATE OF DELIVERED :

OWNER :

OPERATOR :

OPERATOR'S CONTACT PERSON :

(PHONE/FAX) :

ADDRESS OF OPERATOR :

TELEPHONE NUMBER AND EMAIL :

INSPECTOR NAME :

TIME OF INSPECTOR BOARDED :

TIME OF INSPECTOR DEPARTED :

VESSEL OPERATION AT TlME OF INSPECTION :

PRODUCT BEING HANDLED :

LAST PORT STATE CONTROL INSPECTION :

ADDITIONAL COMMENT
1. CERTIFICATION AND DOCUMENTATION
lssue by:
14 FIRE EXTINGUISHER CERTIFICATE lssued Date:
Valid to:
lssued date: 22-Jan-15
SAFE MANNING CERTIFICATE (issued
15 Expiry date: 06-Feb-16
by flag state)
Numbers of crew meet the certificate
lssued Date: 29-Aug-14
DOCUMENT OF COMPLIANCE (for
16 Valid to: 02-Sep-19
Company)
Last Endorsement:
lssued Date: 24-Nov-15
INTERNATIONAL SHIP SECURITY Valid to: 16-Nov-20
CERTIFICATE / STATEMENT OF
17 COMPLIANCE OF PORT FACILITY /
PERNYATAAN PEMENUHAN
KEAMANAN FASILITAS PELABUHAN
Last Endorsement:
lssued by : 20-Feb-11
18 CONTINUOUS SYNOPSIS RECORD
Last internal / external security audit :
lssued by : DITJEN PERLA
CERTIFICATE OF INSURANCE IN lssued Date: 26-Jan-16
19 RESPECT OF CIVIL LIABILITY FOR OIL
POLLUTTON (CLC) Valid to: 20-Feb-17
CERTIFICATE OF FITNESS - lssued Date:
20 GAS (IF APPLTCABLE)
Valid to:
lssued by : JRC
SHORE BASED MAINTENANCE
21 (GMDSS)
Valid to: 16-Sep-19
SHIPBOARD OIL POLLUTION Approved by :
22 EMERGENCY PLAN
(Oil tanker ≥ 150 GT & other shp ≥ 40O GT Date :

23 GARBAGE MANAGEMENT PLAN

(For ship ≥ 400 GT or Certified to carry ≥ 15 Persons)

Laste Entry ?
24 ENGINE ROOM LOG BOOK
Signed by Chief Engineer & Master ? YES
Laste Entry ?
25 OIL RECORD BOOK (Part I & ll)
oil tanker ≥ 150 GT & other shi ≥ 400 GT
(For

Signed by Master ? YES

26 GENERAL ARRANGEMENT Approved by and date:

27 INTACT STABILITY BOOKLET Class approved and date:

28 DAMAGE STABILITY BOOKLET Class approved and date:

APPROVED LOADING COMPUTER OR Approved by:

29 PROGRAMME
(ship of more than 65 meters in length) Date:

30 GAUGING AND SOUNDING DEVICE

(UTI) Last Calibrated?

31 LOADING/DISCHARGING PLAN
 31 LOADING/DISCHARGING PLAN For current & previous voyages?

3. PUBLICATIONS
1 SOLAS 74
(Consolidated Edition 2009)
2 STCW 95 plus amendments (2010)

3 MARPOL 73/78
(Consolidated Edition 2011 )
4 INTERNATIONAL CODE OF SIGNAL
(2005 ed)
5 INTERNATIONAL REGULATIONS FOR
PREVENTING COLREG 1972
6
CAPTAIN MEDICAL GUIDE FOR SHIPS
7 TANKER SAFETY GUIDE

8 ISGOTT 5TH EDITION, 2006 Latest edition

SHIP TO SHIP TMNSFER

9
GUIDE,2014 EDITION
PREVENTION OF OIL SPILLAGES
10 THROUGH CARGO PUMP ROOM Edition

SEA VALVES
CLEAN'SEAS GUIDE FOR OIL
11
TANKERS
Latest edition?
12 LIST OF LIGHTS
Prooerlv corrected?

13 LIST OF RADIO SIGNALS

14 ISPS Code 2003

GUIDELINES FOR CONTROL OF

15
DRUGS & ALCOHOL ON BOARD
16 CRUDE OIL WASHING GUIDE

ARRANGEMENT FOR TANKER

17
MANIFOLD
INTERNATIONAL GAS CARRIER
18
(IGC) CODE

ADDITIONAL COMMENT
3. PUBLICATIONS
1 SOLAS 74 AVAILABLE
(Consolidated Edition 2009)
2 STCW 95 plus amendments (2010) AVAILABLE

3 MARPOL 73/78 AVAILABLE

(Consolidated Edition 2011 )
4 INTERNATIONAL CODE OF SIGNAL AVAILABLE
(2005 ed)
5 INTERNATIONAL REGULATIONS FOR NA
PREVENTING COLREG 1972
6 AVAILABLE
CAPTAIN MEDICAL GUIDE FOR SHIPS
7 TANKER SAFETY GUIDE AVAILABLE

8 ISGOTT 5TH EDITION, 2006 Latest edition 5Th Edition 2006 AVAILABLE

SHIP TO SHIP TMNSFER

9 AVAILABLE
GUIDE,2014 EDITION
PREVENTION OF OIL SPILLAGES
10 THROUGH CARGO PUMP ROOM Edition 2nd Edition 1991 AVAILABLE
SEA VALVES
CLEAN'SEAS GUIDE FOR OIL
11 AVAILABLE
TANKERS
Latest edition?
12 LIST OF LIGHTS AVAILABLE
Prooerlv corrected?

13 LIST OF RADIO SIGNALS AVAILABLE

14 ISPS Code 2003 AVAILABLE

GUIDELINES FOR CONTROL OF

15 AVAILABLE
DRUGS & ALCOHOL ON BOARD
16 CRUDE OIL WASHING GUIDE AVAILABLE

ARRANGEMENT FOR TANKER

17 AVAILABLE
MANIFOLD
INTERNATIONAL GAS CARRIER
18 NA
(IGC) CODE

ADDITIONAL COMMENT
GMDSS CERTIFICATION FOR DECK OFFICER ONLY
RANK NAME LICENCE / GRADE EXPIRY DATE
ISSUING COUNTRY
MASTER BOY RICHARD TOGAS
ANT 1 INDONESIA
CHIEF OFFICER IYYANG
ANT 2 INDONESIA
2ND OFFICER ANDI AHAMAD UNIT
ANT 2 INDONESIA
3RD OFFICER IHSANUDIN
ANT 3 INDONESIA

SHIPS SAFETY OFFICER CERTIFICATION

RANK NAME ISSUING COUNTRY ISSUE DATE REMARK
6. RADIO COMMUNICATION EQUIPMENT
NO EQUIPMENT CONDITION / REMARKS

VHF Radio; Good

Fixed ;
≥

- DSC channel 70 Good

- Working on Ch. 6. 13 & 16 ? Good

Portable
- Number 3 Units

- Complete with charger 2 Hrs

GENERAL GMDSS Portable

(ships ≥ 300 GT) - Number 3 Units
1
- Check Battery

Expiry : Feb.2020
9GHz SARTS (Ships ≥ 300 ~ < 500 =1, ≥ 500 = 2)

- Number 2 Units

- Check Battery / 3 yrs life Expiry :

EPIRB
- Work on 406 MHz?
- Position: Monkey Island
- HRU Validity: Expiry : May 2017
- Check Battery / 3 years life: Expiry : Jan.2017
INMARSAT
- Condition NG
SPARE BATTERY FOR GMDSS
- Condition Good
VESSEL COMPLIES WITH THE
2 GMDSS COVERING SEA AREA YEsS/ NO Yes
A1, A2, A3, A4 (≥ 300 GT)

ADDITIONAL COMMENT
7. SAFETY AND LIVESAVING EQUIPMENT

17 EMERGENCY ESCAPE BREATHING No :

12 UNIT , GOOD CONDITION
DEVICES (EEBD) (min Conditon
2 required ≥ 500 GT)
At galley?
18
FIRE BLANKET AVAILABLE
Accommodation :
19 EMERGENCY LIGHTING Engine Room :
Outside Accommodation :
Medicines & Medical Last Record: AVAILABLE
20
HOSPITAL Call alarm test
Adequate? AVAILABLE
21 FIRST AID KITS
Number & Capacity: 2 UNIT ( 25 PERSONS )
Launching equipment: AVAILABLE
22 LIFEBOATS
Date of last launch: 26-Apr-16
Ooeratino instruction Dosted AVAILABLE
Number & Capacity : 2 UNIT ( 50 PERSONS )
LIFE RAFT 1 UNIT ( 20 PERSONS )
23
HRU Validity: SEP - 2017 & OCT - 2017
Operating instruction posted? AVAILABLE
MOB buoy (P & S), Exp date: Nov-16
Line & lights AVAILABLE
24 LIFEBUOYS Light only N/A
(Under 100 m LOA min 8 pcs) Without line & light: AVAILABLE
Ship's name & Port of Registry? AVAILABLE
Number: 59
LIFE JACKET SOLAS Approved Type? YES
25
With light & whistle: AVAILABLE
Number: 5
26 WORK VEST
Condition: GOOD
Location: PUMP ROOM & AC. ROOM
27 FIXED GAS DETECTOR
Condition: GOOD
Number; 1 UNIT
28 PORTABLE OXYGEN METER
Last calibrated: 30-Jul-14
Number: 3 UNITS
29 PORTABLE GAS DETECTOR
Last calibrated: 22-Apr-16

ADDITIONAL COMMENT
8. SHIP'S STRUCTURE AND ACCOMMODATION
Dry provrsron: GOOD
Chillers: GOOD
15 GALLEYS AND STORE ROOMS Mess room: GOOD
Exhaust fan cleanliness: GOOD
General Condition GOOD
Condition:
16 DECK & ENGINE STOREROOMS GOOD
Condition:
17 ACCOMMODATION LADDERS GOOD
Type of fire ext. system: SPRINKLER SYSTEM
Operational? GOOD
18 PAINT STORAGE
MSDS: AVAILABLE
Location : PORT MAIN DECK
Type of fixed fire ext. system:
Operational?
19 CHEMICAL STORAGE
MSDS:
Location:
Anti-slip surface GOOD
20 DECK WORKNG AREAS
Safety sign / IMO symbol: UPDATED
Free of Fire Hazards YES
21 LAUNDRY RROOM
Free of accumulation clothing YES
Last tested
22 PERSONNEL ALARM
REFRiGERATED SPACES Condition GOOD

ADDITIONAL COMMENT
9. CARGO AND DECK EQUTPMENT
Calibration records:
15 MEASUREMENT EQUIPMENT Bonding cable:
Water finding paste
Location:
16 SAMPLE STORAGE/LOCKER MSDS available?
Sufficient ventilation?
Stainless steel / Coating:
17 CARGO TANKS
Condition:
Ladder:
18 ACCESS
Tank dome
Last tested:
19 HEATING COILS
Condition:
Operational:
20 VALVES
Valve's number marked?
Number:
FIXED TANK CLEANING
21 Operational:
MACHTNES (COW)
Condition:
Number:
PORTABLE TANK CLEANING MACH Operational:
22 INE (for Butterworth washing)
Condition:
Last tested:
23 HIGH LEVEL ALARMS Condition:
Alarm & signal light provided?

ADDITIONAL COMMENT
14. MACHINERY SPACES
AUXILIARY ENGINE / DIESEL Number and capacity:
1 GENERATORS Condition:
Number and capacity:
2 EMERGENCY GENERATOR
Condition:
Number:
3 SEWAGE SYSTEMS Holding Tank Capacity:
Condition?
Number:
4 AIR COMPRESSOR
Condition
Number:
5 BOILERS
Condition
Number:
6 EMERGENCY COMPRESSOR
Condition:
UMS or Manual AMS :
Control Room available?
7 ENGINE CONTROL SYSTEM Machinery alarm system condition?
(minimum required LO low press alarm for M/E,A/E,
Bow thrusters Enqine should be test)
Gauging lndicator Condition:
8 SWITCHBOARD Rubber mats:
Protected against water spray?
Number:
EMERGENCY BATTERIES FOR Maintenance record available?
9
RADIO & LIGHTING Bracket:
Condition:
Capacity:
10 CARGO PUMP
Condition:
Capacity:
11 STRIPPING PUMP
Condition:
Capacity:
12 TANK CLEANING PUMP
Condition:
Capacity:
13 BILGE PUMP
Condition:
Capacity:
14 GS PUMP
Condition:
Capacity:
15 FIRE PUMP
Condition:
Capacity:
16 BALLAST PUMP
Condition:

ADDITIONAL COMMENT
15. CARGO AND BALLAST SYSTEM . PETROLEUM
COMPANY POLICY, GUIDANCE Operator Policy available in SMS
1 AND PROCEDURES WITH Master Standing Order displayed
REGARDS IN CARGO Chief Officer Standing Order displayed
OPERATION All Officers counlersioned
PRECAUTION AGAINT STATIC Loading Rate
2
ELECTRICITY HAZARDS Venting Capacity
Mimic Diagram
3 INFORMATION IN CARGO lnert Gas System
CONTROL AREA Venting System
Number of Pumps
4 CARGO PUMP
Performance curve
5 STABILITY BOOKLET Class / date of approval
STABILITY LOADING Class Approval
6
COMPUTER Accuracy test regularly
PROCEDURE RESTORING Available in Manual
7
STABILITY Officers Familiar with restoring stability
CARGO PLAN PREPARED BY Master approved and signed
8
CHIEF OFFICER Officers countersigned prior cargo operation
Tested annually
9 CARGO PIPELINES TEST
Date of last tested
IF FIXED TANKS GAUGE NOT Portable tapes suffi cienl
10
FITTED Last Calibrated
Last Calibrated:
Last Maintenance:
11 CARGO TANKS VENTING Pressure lndicator / secondary venting
SYSTEM (P/V VALVES)
Alarm low & high pressure
Condition:
Calibrated prior to use
12 FIXED OXYGEN ANALYSER
Chief Officer familiar of the calibration
Line pressure gauge working?
Operation and equipment manual provided
13 CRUDE OIL WASHING
Checklist has been completed prior to use
PIC of COW experience at least one vear
lnitial Rate clearly stated
Maximum Rate clearly stated
14 STATIC ELECTRICITY
PRECAUTION Settling periods delay 30 minutes
Gauqinq or samplinq devices effective bonded

ADDITIONAL COMMENT
17. SAFETY MANAGEMENT SYSTEM
COMPANY POLICY & SAFETY
1 MANAGEMENT SYSTEM
MANUAL
2 SAFETY OFFICER ON BOARD
SAFETY OFFICER FAMILIAR
3
WITH LSA & FFA
OPERATOR REPRESENTATIVE
4
VISIT THE VESSEL
5 INTERNAL AUDIT
DESIGNATED PERSON
6 Name & contact details displayed?
ASHORE (DPA)
7 DRUGS AND ALCOHOL POLICY
8 HAND TORCES LIGHT
9 EMERGENCY PREPAREDNESS
SAFETY TRAINING OF LIFE
10
SAVING APPLIANCE
11 SMOKING POLICY
12 SAFETY MEETING
13 PROCEDURE REPORTING
ADDITIONAL COMMENT
Company Policy displayed?
SMS Manual hard / soft copy?
Last Revision date?
ln-House / Formal training
Date certificate issued
Bi-annually visit?
Date of Last Visit recorded?
Close out system in place for dealing
with nonconformity?
Report last internal audit?
Auditols name and rank?
D & A policy displayed?
Last un-announce D & A test carried out?
Total on board
Approved in use gas-hazardous areas
Are there procedures in place for
- life boat
- fire / cargo tank explosion
- rescue from enclose space
- electric power failure
- main engine failure
- shifting of cargo
- cargo spillage
- search and rescue
- heavy weather damage
- gas toxic release from accommodation
Matrix of safety training
Last training / Topic
Matrix of safety training
Last training / Topic
Minutes of Meeting
Last safety meeting
lncident / Accident
Non-Conformity
Near Misses
 APPENDIX A

OBSERVATIONS & RECOMENDATION

A. HIGH (ITEMS THAT MUST BE CLOSED PRIOR ACCEPTANCE)

B. MEDIUM (ITEMS CAN BE CLOSED DURING FINAL SITE INSPECTION PRIOR COMMENCE OPERATION)

C. LOW (OBSERVATIONS ARE FOR INFORMATION ONLY FOR CONTINUOUS IMPROVEMENT)

ATTENDING COS DATE :

SURVEYOR :

CHECKED & APPROVED : DATE :

 SHIP'S PARTICULARS
Page : 1/2

Name of Ship : MT. SURYA PUTRA JAYA ( EX - HIGH LAND )

Call Sign : PNRP
Flag : Indonesia
Port of Register : Jakarta
IMO Number : 9018426
Registration Mark : 2010 Pst No. 6570/L
MMSI : 525017099
Type of Ship : Oil tanker
Type of Hull : Double Hull
Builder : Imabari Shipbuilding Co., Ltd. Marugame, Japan
Keel laid : 12 June 1991
Launched : 22 January 1992
Delivered : 04 January 1992
Class : NK and BKI
P&I Club : UK Club

Dimensions : Parallel Mid - Body Diagram

L.O.A 181.61 M Bow to mid-point manifold
L.B.R 172.00 M Stern to mid-point manifold
Extr. Breath 30.026 M Light ship parallel body length
Mould. Breath 30.00 M Light ship parallel body-bow to mid-point manifold
Keel-Head mast 47.90 M Light ship parallel body - Stern to mid-point manifold
Bow-Bridge 150.30 M Normal ballast parallel body length
Bridge front-Mid point manifold 58.382 M Normal ballast par. body length - Bow to mid-point manifold
Depth moulded 18.40 M Normal ballast par. body - Stern to mid-point manifold
Keel-CM 20.40 M Parallel body length at SDWT
M.Deck-WING 11.40 M Parallel body length at SDWT - Bow to manifold
Parallel body length at SDWT - Stern to manifold

Tonnage: Load Line:

NRT 11222 Freeboard(m) Draft(m) DWT(t)
GRT 25808 Tropical fresh water 6,153 12,276 42,571
Suez 25177.29 Tropical: 6,418 12,011 42,597
Panama 21460 Summer: 6,663 11,766 41,460
Winter: 6,908 11,521 40,308
FWA 256 mm Lightship: 16,206 2.22 0
TPC 46.7 t/cm Normal ballast condition: 11,689 6.74 18,850
Segregated ballast condition: 11,319 7.11 20,100

Cargo Tanks (M3) Ballast tanks (m3) 100%

No. 100% 98% 95% S.B.T No. Port (m³) Stbd (m³) Total (m³)
1 C.O.T 4431.5 4342.9 4209.9 FPT 773.4
2 C.O.T 6108.3 5986.1 5802.9 No.1 1013.5 1013.5 2027.0
3 C.O.T 6754.4 6619.3 6416.7 No.2 1127.8 1127.8 2255.6
4 C.O.T 6796.8 6660.9 6457.0 No.3 1025.1 1025.1 2050.2
5 C.O.T 6796.8 6660.9 6457.0 No.4 1008.1 1008.1 2016.2
6 C.O.T 6795.1 6659.2 6455.3 No.5 1008.1 1008.1 2016.2
7 C.O.T 6754.7 6619.6 6417.0 No.6 1008.1 1008.1 2016.2
8 C.O.T 5987.2 5867.5 5687.8 No.7 1004.8 1004.8 2009.6
Total = 50424.8 49416.4 47903.6 No.8 1210.8 1210.8 2421.6
APT 442.3
Slop Tanks (M3) Total ballast tank capacities at 100% full : 18028.2
Slop (P) 569.9 558.5 541.4
Slop (S) 569.9 558.5 541.4
Total = 1139.8 1117.0 1082.8 LAST DOCKING : 20TH OCTOBER 2010
am
91.918 M
89.69 M
55.50 M
28.10 M
27.40 M
81.30 M
44.00 M
37.30 M
89.00 M
44.30 M
45.20 M

Displ.(t)
50,809
50,835
49,688
48,546
8,238
27,088
28,338