Ingangsdatum:
13-09-1994
Geldig tot en met:
20-08-1998
A. Vessel identification Name of vessel: Owner: Year built:
Flag:
Call sign: Gross tonnage:
Port of registry: Length overall:
Vessel's international call sign, if available:
Classification society:
Class notation:
Hull: Machinery:
Propulsion machinery: Output:
Agent:
Draught: Forward: Amidships: Aft:
Volume/mass of dangerous or polluting cargo:
B. Safety installations aboardIn good working order Yes No Deficiencies 1. Construction and
technical equipment
Main and auxiliary engines
Main steering gear
Auxiliary steering gear
Anchor gear
Fixed fire-extinguishing
system
Inert gas system (if applicable)
2.
Navigational equipment
Manoeuvring characteristics available
First radar installation
Second radar
installation
Gyro compass
Standard
magnetic compass
Radio direction-finding apparatus
Echo-sounding device
Other electronic
position-fixing aids
3. Radio equipment
Radiotelegraphy installation
Radiotelephony installation (VHF)
C. DocumentsCertificates/documents valid on board Yes No Cargo ship safety
construction certificate
Cargo ship safety equipment certificate
Cargo ship safety radio telegraphy certificate
Cargo ship safety radio telephony certificate
Load line certificate
Classification
certificate
Pollution risk insurance certificate
Solas dangerous goods certificate
Passenger safety certificate
Oil/cargo
record book filled in
(International) certificate of fitness for
the carriage of dangerous chemicals in bulk
(International)
certificate of fitness for the carriage of liquefied in bulk
International oil pollution prevention certificate (IOPP
certificate)
International pollution prevention certificate for
the carriage of noxious liquid substances in bulk
D.
Officers and ratingsCertificate of competency (detailed description and serial
number) Issued by (issuing authority) At (place/country) Yes No Master
Chief mate
Second mate
Third mate
Chief engineer
First engineer officer
Second engineer
officer
Third engineer officer
Radio
officer
Total number of ratings Deck Engine room
Deep-sea pilot taken aboard
Date Signature
of the master or, if he is indisposed, of the deputy