Deck Forms

Inventory of Forms MOTNHLY QUARTERLY CHECKLISTS
Vessel FSO Surya Putra Ja M 01 Safety Equipment Q 01 Safety Equipment C 01 Arrival Check
Nationality of ship Indonesia M 02 Maint Report Deck Q 02 Lashing Equipment C 02 Departure Check
IMO No. 9018426 M 03 Greasing / Hull Q 03 Security Equipment C 03 Familiarisation
Gross Tonnage 25808 M 04 Paint Inventory Q 04 Tank Summary C 04 Master Change
Call Sign PNRP M 05 Training Plan FAL FORMS C 05 Welding Work
Master Ihwan Asrul M 06 - M 12 Rest Time F 01 Crew List C 06 Outboard / Aloft Work
Voyage No 01/14 Form M 13 Watch Plan F 02 Passenger List C 07 Enclosed Spaces
Year 2014 M 14 Stability Report F 03 Ship Stores C 08 Change over SO
Month January M 15 Monthly Statement F 04 Crew Effects C 09 Change over CO
Port of arrival Oyong Terminal M 16 Taining Report F 05 General Declaration
Date of arrival 01/01/14 F 08 Vaccination List Crew Fam 04Crew Fam 05
Port arrived from Batam M 07 M 08 F 09 Declaration of Health Crew Fam 02Crew Fam 03
Period of stay 365 M 09 M 10 F 10 Schedule to the DoH Crew Fam 04Crew Fam 05
Port of Departure Oyong Terminal M 11 M 12 I 01 Declaration of SecurityI 01 ISPS Familiarization
Next Destination Oyong Terminal
Date of Departure 31/12/14

FORM 00
PT. CAKRA BAHANA Inventory Delivery List
Deck
Master Ihwan Asrul Month: January

Back
Vessel FSO Surya Putra Jaya Year: 2014
Form Title Rev Resp. To do Print out Sign
Inventory and Delivery List 06 Master x x
Weekly W 01 Safety Equipment 06 SO weekly
Monthly M 01 Safety Equipment 06 SO monthly

M 02 Maint Report Deck 06 CO monthly
M 03 Greasing / Hull 06 CO monthly
M 04 Paint Inventory 06 CO monthly
M 05 Training Plan 06 SO monthly
M 0 6- M 12 Rest & Over Time 06 CO monthly x x
M 13 Watch Plan 06 CO monthly x x
M 14 Stability Report 06 Staff monthly x x
M 15 Monthly Statement 06 Staff monthly x x
M 16 Training Report 06 CO monthly x x
Quarterly Q 01 Safety Equipment 06 Master quarterly

Q 02 Lashing Equipment 06 SO quarterly
Q 03 Security Equipment 06 Master quarterly
Q 04 Tank Summary 06 Master quarterly
FAL F 01 Crew List 06 Master if changed x x

F 02 Passenger List 06 Master if applicable x x
F 03 Ship Stores 06 Master
F 04 Crew Effects 06 Master
F 07 General Declaration 06 Master
F 08 Vaccination List 06 Master
F 09 Declaration of Health 06 Master
F 10 Schedule to the DoH 06 Master
On
Demand O 01 Certificates 06 Master
O 02 Master Review 06 Master Handing Over x x
O 03 SMS Report 06 Master if applicable x x
O 05 Requisition List 06 Master if applicable x x
O 06 Container Damages 06 CO
O 07 Steved Dam Rep 06 CO
O 08 Summary Damages 06 CO
O 09 Voyage Plan 06 Master
O 10 Tank Report 06 CO Tk open x x
O 11 Port Stay Em List 06 CO
O 12 Notice of Readiness 06 Master
Checklst C 01 Arrival Check 06 WO

C 02 Departure Check 06 WO
C 03 Familiarisation 06 Master all x x
C 04 Handing Over Master 06 Master all x x
C 05 Welding Work 06 CO/CE
C 06 Outboard / Aloft Work 06 CO/CE
C 07 Enclosed Spaces 06 CO/CE
C 08 Handing Over CO 06 CO all x x
C 09 Handing Over SO 06 SO all x x
ISPS I 01 Declaration of Security 06 SSO all x x

I 01 ISPS Familiarization 06 SSO all x x
I 03 Last 10 Ports of call 06 SSO
Revision: 0 Approved by DP Page 2 of 81

FORM 00
PT. CAKRA BAHANA Inventory Delivery List
Deck
Remark:
Generally the whole XLS file will be sent to the office. Additionally all forms marked with 'print out' and/or
signed' have to be sent accordingly.
It is supposed to have from all forms only one and the latest version for documentation on board. No other
SMS forms, especially from other companies, are allowed.
Any change/improvement has to be announced to the office in advance, before it is done!
Herewith we confirm to have sent the crossed forms to the office with the requested content and we sign for the correct filling.
Further a copy for this month is filed on board in electronic format.
Master CO Date
Revision: 0 Approved by DP Page 3 of 81

FORM W 01
MARSIG mbH Maintenance Safety Equipment
weekly check
MV: FSO Surya Putra Jaya Year: 2014
Back Master: Ihwan Asrul Month: January
last Maint 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56
Navigations Lights / Signalling Lamps 1-Jan-14
Navigation Lights, Anchor and Not-under command
lights working 1-Jan-14 x
Distribution panel and relevant alarms in working
condition 01.02.08 x
Test on main and emergency source of power 01.02.08 x
Check Signalling Lamps correctly operate, charged
and spares are available 01.02.08 x
Check the portable Battery to be fully charged,
covers and carrying strap. 01.02.08 x
Indicators
Speed and Distance indicators in working condition

01.02.08 x
Rudder angle indicator correctly operational 01.02.08 x
Propeller rate of revolution indicators operational
01.02.08 x
Variable pitch propeller indicator operational 01.02.08 x
Radio & Telephony Equipment / GMDSS-
Installation
NAVTEX receiver run self-test program 01.02.08 x
INMARSAT EGC facility run self-test program 01.02.08 x
Ship earth station facility run self-test program 01.02.08 x
Check VHF T+R for satisfactory operation (Channels
6, 13, 16) 01.02.08 x
Check VHF DSC watch receiver operation (CH 70)
01.02.08 x
Check MF DSC operation (Frequency 2187.5 KHz)
01.02.08 x
Check MF T+R operation (Frequency 2187.5 KHz)
01.02.08 x
Check MF/HF DSC operation (4207.5-6312-8414.5-
12577-16804.5 KHz) 01.02.08 x
Check MF/HF T+R (2174.5-4177.5-6268-8376.5-
12520-16695 KHz) 01.02.08 x
Check Distress watch receiver - Preset on 2182 KHz
01.02.08 x
Check Distress watch receiver - mute / demute
function, loud speakers 01.02.08 x
Call sign, Station identify and other required codes
clearly marked 01.02.08 x
Instruction card for Distress procedures displayed
01.02.08 x
Last maintenance 01.02.08 x
Portable Two-way VHF Radio Telephone
Two-way VHF radios and valid batteries 01.02.08 x

Check charger activity & function 01.02.08 x
Check spare number of spare batteries 01.02.08 x
Compasses
Magnetic Compasses liquid level satisfactory 01.02.08 x

Speaking tube between standard compass and
steering position 01.02.08 x
Magnetic Compass table / curve deviation records
maintained 01.02.08 x
Gyrocompass and repeaters in good operational
condition 01.02.08 x
Off-Course alarm / indicators are functioning correct
01.02.08 x
Fire detecting system (loop-wise)
Revision: 01.01.2008 Approved by DP Page 4 of 81

FORM W 01
Back
weekly check
last Maint 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56
Navigations Lights / Signalling Lamps 1-Jan-14
Navigation Lights, Anchor and Not-under command
lights working 1-Jan-14 x
Sample check of sensors (10 % each week) 01.02.08 x
Check if alarm is heard on bridge or indicated 01.02.08 x
General Alarm System
Test of general alarm,-Check that all bells, horns,

whistles are heard well 01.02.08 x
Activation of General Alarm by fire detection panel
01.02.08 x
Emergency escape
Check for easy opening of doores, windows. Check

for clear passage through escape doors. Check
escape ropes and lights in escape trunks 01.02.08 x
Fire fighting
Check fire pumps and supply water with sufficient

pressure on the highest deck with at least two jets.
Operate pumps by remote start. 01.02.08 x
Close / open check of fire line isolating valves 01.02.08 x
Check easy operation of dampers and open/close
position is properly marked. 01.02.08 x
Check of fuel and oil tanks gauge glases for correct
position of cocks. 01.02.08 x
Life boats, rescue boats, life rafts x
Visual inspection. Check for damages and correct
operation, retro-reflective tapes ... 01.02.08 x
Operate engines for at least 5 minutes, test gear
ahead/astern check oil and fuel levels. 01.02.08 x
Check / Inspect / Update life boat / rescue boat
equipment 01.02.08 x

FORM M 01
monthly check

Month 2008 Month 2009
last Maint 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 10 11 12
Plans and Instructions 01.02.08 x

Records 01.02.08 x
Navigational equipment 01.02.08 x
Steering gear 01.02.08 x
Navigation lights 01.02.08 x
Tests 01.02.08 x
Magnetic deviation table 2 years x
Fire fighting and response equipment
Check of fire stations 01.02.08 x
Check of fire boxes 01.02.08 x
Check of fire extinguishers 01.02.08 x
Check of fixed fire fighting eq. 01.02.08 x
Communication equipment
Working condition 01.02.08 x
Antenna system 01.02.08 x
EPIRB 01.02.08 x
SAR 01.02.08 x
GMDSS 01.02.08 x
Safety Equipment
Check of safety equipment 01.02.08 x
Life boat 01.02.08 x
Liferafts 01.02.08 x
Lifebuoys 01.02.08 x
Lifejackets 01.02.08 x
Survival suites 01.02.08 x
Thermal protective aids 01.02.08 x
Other Life Saving Appliances 01.02.08 x
Medical Equipment
Medical locker 01.02.08 x
Completeness & expiry dates 01.02.08 x
Pollution response equipment
Completeness & condition 01.02.08 x x
Remarks:

FORM M 02
MARSIG mbH Maintenance report
Deck
Oyong Terminal FSO Surya Putra Jaya

Back January Ihwan Asrul
Date
3-Jul-06 painting aft bollards distribution of lashing equipment
cleaning inside superstructure
4-Jul-06 distribution of lashing equipment cleaning inside superstructure
5-Jul-06 distribution of lashing equipment cleaning inside superstructure
6-Jul-06 quick acting cleat check/adjustment distribution of lashing equipment
7-Jul-06 Securing first aid kits securing opening the fridge in officer messroom
8-Jul-06 Greasing vent mashrooms fixing bridge port side chair
9-Jul-06 quick acting cleat check/adjustment drain plugs dismountled/greased/placed back
installation of international shore connection greasing butterfly nuts
Fitting ratguards with ropes cleaning inside superstructure
10-Jul-06 quick acting cleat check/adjustment drain plugs dismountled/greased/placed back
making stencils on garbage station fabricating hinges on lifejacket box
Cleaning air-condition room

FORM M 03
MARSIG mbH
Greasing

2008 2009 2010 2011
AREA Maintenance 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12
Winches monthly
Fore 01.02.08
Aft 01.02.08
Miscellaneous monthly
Fire hose couplings 01.02.08
Fire hydrants & nozzles 01.02.08
Firemains drain valves 01.02.08
Anchor quick-realising device 01.02.08
Anchor covers, bolts+nuts 01.02.08
Fire-Flaps monthly
Poopdeck 01.02.08
A-Deck 01.02.08
B-Deck 01.02.08
C-Deck 01.02.08
D-Deck 01.02.08
E-Deck 01.02.08
F-Deck 01.02.08
Funnel 01.02.08
ER ventilation fire dampers 01.02.08
Lashing Material monthly
Greasing 01.02.08
Hull inspection quarterly
Ship side shell plates 01.02.08
Condition of cargo holds 01.02.08
Watertight doors 01.02.08
Manhole covers 01.02.08
Bulkheads, frames 01.02.08
Tank top, brackets 01.02.08
Catwalks, handrails, bulwarks 01.02.08
Crane No. 1 quarterly
Nipples 01.02.08
Wires 01.02.08
Crane No. 2 quarterly
Nipples 01.02.08
Wires 01.02.08
Prov. Crane No. 1 quarterly

FORM M 03
MARSIG mbH
Greasing
Back
2008 2009 2010 2011
AREA Maintenance 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12
Nipples 01.02.08
Wires 01.02.08
Prov. Crane No. 2 quarterly
Nipples 01.02.08
Wires 01.02.08
Accomodation Ladders quarterly
Nipples 01.02.08
Wire 01.02.08
Lifeboat-Davit quarterly
Nipples 01.02.08
Wire 01.02.08
Rescueboat-Crane quarterly
Nipples 01.02.08
Wire 01.02.08
Miscellaneous quarterly
Manhole-Entries 01.02.08
Ventilator-Heads 01.02.08
Vent-Flaps Fwd. 01.02.08
Vent-Flaps Aft 01.02.08
Valves 01.02.08

FORM M 04
MARSIG mbH
Paint Inventory

Balance ROB
Paint Type Schade No Deck Engine Order
Ltr
Sigma 1199 topacryl finish blue 140 20 120
Sigma 7000 sigma enamel white 140 20 120
Sigma undercoat white 60 60
Sigma 4199 topacryl finish green 160 40 120
Sigma 2182 topacryl finish brown 100 80 20
Sigma 3179 topacryl finish buff 110 30 80
Sigma 5177 topacryl finish grey 140 60 80
Sigma sigmaplane TA redbrown 0
Sigma sigma fluorescent orange 40 40
Sigma 6188 sigmarine BTD red 40 40
Sigma multiprimer redbrown 60 60
Sigma multiprimer grey 60 60
Sigma chlor primer grey 80 40 40
Sigma multimastic redbrown 6179 60 60
Sigma multimastic grey 5177 60 40 20
Sigma thinner 20-05 80 80
Sigma thinner 21-06 140 20 120
Sigma thinner 91-92 120 120
Sigma 1188 topacryl finish blue 0
Sigma 7000 sigmaguard CSF 75 0
Sigma 3138 sigmarine BTD yellow 20 20
Sigma 7261 alluminium HR 500 35 35
Sigma 7260 alluminium HR 45 45
Sigma 8000 topacryl finish black 80 20 60
Sigma 4171 sigmarine BTD green 80 20 60
Sigma 7568 silicate MC pigment 0 140*
Sigma 7417 universal primer 80 80
Sigma 7238 yellow 45 45
Sigma 7240 enamel white 120 120
Sigma 7469 miocoat gray 0 60*
Sigma 7466 sigma coating 80 80
Hardener 20 20
Sigma 1154 Anti-fouling redbrown 100 100
0
0
0
0
0
0
0
0
0
0
0
Remarks

Form M 05
DRILL AND TRAINING PLAN according to SOLAS, MARPOL, ISM, ISPS

January February March April May June July August September October November December
Fire Drill (including First Aid) x x x x x x x x x x x x

(done) fill in date >
Abandon Ship x x x x x x x x x x x x
(done) >
Man over Board, SAR x x x x

(done) >
Oil Spill x x x x
(done) >
Emergency Steering x x x x
(done) >
EEBD - training x x
(done) >
Collision x
(done) >
Grounding / Flooding x
(done) >
Main Engine Failure x

(done) >
ISPS * x x x x
(done) >
Communication - office x
(done) >
Remarks: - If not possible to hold the schedule, make note in the log book. The special training should be made in the next month additionally.
- Several training tasks can be added in one training session of course (e.g. collision, fire and emergency steering drill)
* - ISPS drills have to be carried out at least per quarter and in acc. to ISPS Code part B, chapter 13.6 (drill topics acc. 8.9)

Form M 06
MARSIG mbH
Rest Time
MV: FSO Surya Putra Jaya Rank: 2nd officer Month: January
Back Name: Year: 2014
Please mark periods of work with 'x'
Saturday
Sunday
Hours 00- 01- 02- 03- 04- 05- 06- 07- 08- 09- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- 21- 22- 23- Hours of rest Hours of rest Overtime
Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 in 24-hrs in 7 days
1 x x x x x x x x x x 14 2
2 x x x x x x x x x 15 1
3 x x x x x x x x x 15 1
4 s x x x x x x x x x 15 9
5 x x x x x x x x x 15 1
6 x x x x x x x x x 15 1
7 s x x x x x x x x x 15 104 9
8 x x x x x x x x x 15 1
9 x x x x x x 18
10 x x x x x x x x 16
11 x x x x x x x x x x x x x 11 5
12 x x x x x x x x 16
13 s x x x x x x x x x x 14 10
14 x x x x x x x x 16 106
15 x x x x x x x x 16
16 x x x x x x x x 16
17 x x x x x x x x 16
18 x x x x x x x x 16
19 x x x x x x x x 16
20 x x x x x x x x 16
21 x x x x x x x x 16 112
22 x x x x x x x x 16
23 x x x x x x x x 16
24 x x x x x x x x 16
25 x x x x x x x x 16
26 x x x x x x x x 16
27 x x x x x x x x 16
28 x x x x x x x x 16 112
29 x x x x x x x x 16
30 x x x x x x x x 16
31 24
Confirmation by crewmember: Rest Time total: 490 OT totaL: 40

Form M 07
MARSIG mbH
Rest Time
Saturday
Sunday
1 x x x x x x x x x x 14 2
2 x x x x x x x x x 15 1
3 x x x x x x x x x 15 1
4 s x x x x x x x x x 15 9
5 x x x x x x x x x 15 1
6 x x x x x x x x x 15 1
7 s x x x x x x x x x 15 104 9
8 x x x x x x x x x 15 1
9 x x x x x x 18
10 x x x x x x x x 16
11 x x x x x x x x x x x x x 11 5
12 x x x x x x x x 16
13 s x x x x x x x x x x 14 10
14 x x x x x x x x 16 106
15 x x x x x x x x 16
16 x x x x x x x x 16
17 x x x x x x x x 16
18 x x x x x x x x 16
19 x x x x x x x x 16
20 x x x x x x x x 16
21 x x x x x x x x 16 112
22 x x x x x x x x 16
23 x x x x x x x x 16
24 x x x x x x x x 16
25 x x x x x x x x 16
26 x x x x x x x x 16
27 x x x x x x x x 16
28 x x x x x x x x 16 112
29 x x x x x x x x 16
30 x x x x x x x x 16
31 24

Form M 08
MARSIG mbH
Rest Time
Saturday
Sunday
1 x x x x x x x x x x 14 2
2 x x x x x x x x x 15 1
3 x x x x x x x x x 15 1
4 s x x x x x x x x x 15 9
5 x x x x x x x x x 15 1
6 x x x x x x x x x 15 1
7 s x x x x x x x x x 15 104 9
8 x x x x x x x x x 15 1
9 x x x x x x 18
10 x x x x x x x x 16
11 x x x x x x x x x x x x x 11 5
12 x x x x x x x x 16
13 s x x x x x x x x x x 14 10
14 x x x x x x x x 16 106
15 x x x x x x x x 16
16 x x x x x x x x 16
17 x x x x x x x x 16
18 x x x x x x x x 16
19 x x x x x x x x 16
20 x x x x x x x x 16
21 x x x x x x x x 16 112
22 x x x x x x x x 16
23 x x x x x x x x 16
24 x x x x x x x x 16
25 x x x x x x x x 16
26 x x x x x x x x 16
27 x x x x x x x x 16
28 x x x x x x x x 16 112
29 x x x x x x x x 16
30 x x x x x x x x 16
31 24

Form M 09
MARSIG mbH
Rest Time
Saturday
Sunday
1 x x x x x x x x x x 14 2
2 x x x x x x x x x 15 1
3 x x x x x x x x x 15 1
4 s x x x x x x x x x 15 9
5 x x x x x x x x x 15 1
6 x x x x x x x x x 15 1
7 s x x x x x x x x x 15 104 9
8 x x x x x x x x x 15 1
9 x x x x x x 18
10 x x x x x x x x 16
11 x x x x x x x x x x x x x 11 5
12 x x x x x x x x 16
13 s x x x x x x x x x x 14 10
14 x x x x x x x x 16 106
15 x x x x x x x x 16
16 x x x x x x x x 16
17 x x x x x x x x 16
18 x x x x x x x x 16
19 x x x x x x x x 16
20 x x x x x x x x 16
21 x x x x x x x x 16 112
22 x x x x x x x x 16
23 x x x x x x x x 16
24 x x x x x x x x 16
25 x x x x x x x x 16
26 x x x x x x x x 16
27 x x x x x x x x 16
28 x x x x x x x x 16 112
29 x x x x x x x x 16
30 x x x x x x x x 16
31 24

Form M 10
MARSIG mbH
Rest Time
Saturday
Sunday
1 x x x x x x x x x x 14 2
2 x x x x x x x x x 15 1
3 x x x x x x x x x 15 1
4 s x x x x x x x x x 15 9
5 x x x x x x x x x 15 1
6 x x x x x x x x x 15 1
7 s x x x x x x x x x 15 104 9
8 x x x x x x x x x 15 1
9 x x x x x x 18
10 x x x x x x x x 16
11 x x x x x x x x x x x x x 11 5
12 x x x x x x x x 16
13 s x x x x x x x x x x 14 10
14 x x x x x x x x 16 106
15 x x x x x x x x 16
16 x x x x x x x x 16
17 x x x x x x x x 16
18 x x x x x x x x 16
19 x x x x x x x x 16
20 x x x x x x x x 16
21 x x x x x x x x 16 112
22 x x x x x x x x 16
23 x x x x x x x x 16
24 x x x x x x x x 16
25 x x x x x x x x 16
26 x x x x x x x x 16
27 x x x x x x x x 16
28 x x x x x x x x 16 112
29 x x x x x x x x 16
30 x x x x x x x x 16
31 24

Form M 11
MARSIG mbH
Rest Time
Saturday
Sunday
1 x x x x x x x x x x 14 2
2 x x x x x x x x x 15 1
3 x x x x x x x x x 15 1
4 s x x x x x x x x x 15 9
5 x x x x x x x x x 15 1
6 x x x x x x x x x 15 1
7 s x x x x x x x x x 15 104 9
8 x x x x x x x x x 15 1
9 x x x x x x 18
10 x x x x x x x x 16
11 x x x x x x x x x x x x x 11 5
12 x x x x x x x x 16
13 s x x x x x x x x x x 14 10
14 x x x x x x x x 16 106
15 x x x x x x x x 16
16 x x x x x x x x 16
17 x x x x x x x x 16
18 x x x x x x x x 16
19 x x x x x x x x 16
20 x x x x x x x x 16
21 x x x x x x x x 16 112
22 x x x x x x x x 16
23 x x x x x x x x 16
24 x x x x x x x x 16
25 x x x x x x x x 16
26 x x x x x x x x 16
27 x x x x x x x x 16
28 x x x x x x x x 16 112
29 x x x x x x x x 16
30 x x x x x x x x 16
31 24

Form M 12
MARSIG mbH
Rest Time
Saturday
Sunday
1 x x x x x x x x x x 14 2
2 x x x x x x x x x 15 1
3 x x x x x x x x x 15 1
4 s x x x x x x x x x 15 9
5 x x x x x x x x x 15 1
6 x x x x x x x x x 15 1
7 s x x x x x x x x x 15 104 9
8 x x x x x x x x x 15 1
9 x x x x x x 18
10 x x x x x x x x 16
11 x x x x x x x x x x x x x 11 5
12 x x x x x x x x 16
13 s x x x x x x x x x x 14 10
14 x x x x x x x x 16 106
15 x x x x x x x x 16
16 x x x x x x x x 16
17 x x x x x x x x 16
18 x x x x x x x x 16
19 x x x x x x x x 16
20 x x x x x x x x 16
21 x x x x x x x x 16 112
22 x x x x x x x x 16
23 x x x x x x x x 16
24 x x x x x x x x 16
25 x x x x x x x x 16
26 x x x x x x x x 16
27 x x x x x x x x 16
28 x x x x x x x x 16 112
29 x x x x x x x x 16
30 x x x x x x x x 16
31 24

FORM M 13
MARSIG mbH
Watch Plan

Back
Master: Ihwan Asrul Month: January
THE WATCHKEEPING SYSTEM ON THIS VESSEL IS

ARRANGED ACCORDING STCW 95, PART A, CHAPTER 8,
SECTION 2, THE FLAG STATE REQUIREMENTS AND THE
WORKING TIME OF THE CREW.
Master 0800 - 1200 and 2000 - 2400
Ch.Mate 0400 - 8000 and 1600 - 2000
2nd Mate 0000 - 0400 and 1200 - 1600
3rd Mate 0800 - 1200 and 2000 - 2400
Ch. Engr 0600 - 1200 and 1800 - 2400
2nd Engr 1200 - 1800 and 0000 - 0600
Electrician 0800 - 1200 and 1300 - 1700
Bosun 0600 - 0730 and 0800 - 1200 1300 - 1800
A.B. 0600 - 0730 and 0800 - 1200 1300 - 1800
A.B. 0800 - 1200 and 2000 - 2400
A.B. 0400 - 8000 and 1600 - 2000
O.S. 0000 - 0400 and 1200 - 1600
O.S. 0800 - 1200 and 1300 - 1800
Fitter 0800 - 1200 and 1300 - 1800
Oiler 0800 - 1200 and 2000 - 2400
Oiler 0400 - 8000 and 1600 - 2000
Cook 0600 - 0830 and 0900 - 1300 1500 - 2000
Messman 0600 - 0830 and 0900 - 1300 1500 - 2000
WATCH AND WORKING TIMES ARE ARRANGED FOR SEA AND MAY DIFFER IN THE PORT. MASTER TO BE RESPONSIBLE TO TAKE CARE
THAT REST TIMES WILL BE HOLD AS PER ILO REGULATION MENTIONED BELOW.
IN ADDITION TO THE ABOVE GIVEN WORKING TIMES THE ENGINEER IS ENGAGED ALSO IN CASE OF AN ENGINE ALARM. MASTER IS
AVAILABLE AT ALL TIMES! OVERTIMES IF REQUIRED TO BE CARRIED OUT UPON MASTERS REQUEST. REST TIMES TO BE ACCORDING
C180 SEAFARER’S HOURS OF WORK
EVIDENCE OF REST TIMES WILL BE MADE BY THE OVERTIMES SHEET FORM ON BOARD AND IS AVAILABLE AT ALL TIMES AT THE
MASTERS OFFICE.

FORM M 13
MARSIG mbH
Watch Plan
Signature Master

FORM M 14
MARSIG mbH
Stability Report

Monthly Stability Report
Draught Cargo loaded Ballast Fuel GM

Date Voyage Port of Departure
Fwd Aft 20' 40' others mt mt mt m
03/12 003 Tallinn 5.45 6.40 2 46 117 1610 264.5 3.07
03/12 003 Helsinki
06/12 004 Bremerhaven
07/12 004 Hamburg
10/12 004 Helsinki
14/12 005 Hamburg
17/12 005 Tallinn
18/12 005 Helsinki
22/12 006 Hamburg
28/12 006 St.Petersburg
Total carried this month 2 46 0 117
Master: C/O:
Copies: Ship's file; Owner's file

MARSIG mbH Form M 15
Monthly Statement
MV: FSO Surya Putra Jaya Port: Oyong Terminal

Back Voyage No.: 01/14 Date: 11/04/2018
Monthly Statement
Herewith the ship staff has to confirm to hold following requirements or has to give a clear statement why it was
not possible to act accordingly:
1) Voyage Planning - STCW 95, Section A-VIII/2, Part 2
The voyage planning is done and documented according STCW 95, Section A-VIII/2, Part 2
in consideration of Form O 11 Voyage Plan
in consideration of relevant IMO Circulars
2) Watchkeeping at sea - STCW 95, Section A-VIII/2, Part 3
The navigational watchkeeping is done and documented according STCW 95, Section A-VIII/2, Part 3
-Priciples
-Lookout - STCW 95, Section A-VIII/2, Part 3-1
-Watch arrangements - STCW 95, Section A-VIII/2, Part 3-1
-Taking over the watch - STCW 95, Section A-VIII/2, Part 3-1
-Performing of watch - STCW 95, Section A-VIII/2, Part 3-1
-Nav. Watchkeeping under different conditions - Part 3-1
A&B - Circular - 01-001-98
A&B - Circular - 01-002-98 (additional look out during darkness)
COLREG
Standing orders of company / master for deck department
Watch order book - deck
The Watch Alarm on the bridge is in use during sea trial and safed against unauthorized switch off.
The keys from the Watch Alarm are in master's hands.
The engineering watchkeeping is done and documented according STCW 95, Section A-VIII/2, Part 3-2
-Principles
-Taking over the watch - STCW 95, Section A-VIII/2, Part 3-2
-Performing of watch - STCW 95, Section A-VIII/2, Part 3-2
-Eng. watchkeeping under different conditions - Part 3-2
Standing orders of company / chief engineer for engine department
Watch order book - engine
The radio watchkeeping is done and documented according STCW 95, Section A-VIII/2, Part 3-3
-Principles
-Performing of radiowatch - STCW 95, Section A-VIII/2, Part 3-3
3) Watchkeeping in port - STCW 95, Section A-VIII/2, Part 4
-Principles
-Watch arrangements - STCW 95, Section A-VIII/2, Part 4
-Taking over the watch - STCW 95, Section A-VIII/2, Part 4
-Taking over the deck watch - STCW 95, Section A-VIII/2, Part 4-1
-Taking over the engine watch - STCW 95, Section A-VIII/2, Part 4-2
-Performing the deck watch - STCW 95, Section A-VIII/2, Part 4-3
-Performing the engine watch - STCW 95, Section A-VIII/2, Part 4-4
-Watch in port on ships carrying hazardous cargo - Part 4-5
4) ISM / ISPS System
-The watch on bridge and in the engine was carried out according all mentioned requirements and rules
-All crewmembers fully aware of the SMS of the company 'Klingenberg Bereederungs- und Befrachtungs OHG'
5) Remarks
-Please make remarks (here or on seperate paper), if some facts not clear or relevant documents not on board
-Questions and comments are more than welcome
Master Chief Officer Chief

MARSIG mbH Form M 15
Monthly Statement
Stamp

FORM M 16
MARSIG mbH
Training Report

✘ ✘ ✘
Video ISM ISM annual exercise ISPS ISPS annual exerci MARPOL EEBD MOB Launching Freefall
Place: At sea
Date: 01.12.2005
Description: xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Suggestions for
SMS improvement
Signatures: Mustermann Wilfried Master _____________________________________
Meier
_____________________________________
Willi
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
Anton AB

FORM Q 01
quarterly other intervals
MV: FSO Surya Putra Jaya 2014

Back Master: Ihwan Asrul January
2008 2009 2010
Last
Maintenance
I II III IV I II III IV I II III IV
Quarterly
Rescue Boats
Visual inspection. Check for damages and correct operation, retro-reflective tapes ... 2/1/2008 x x x x x x
Check / Inspect / Update Rescue boat equipment 2/1/2008 x x x x x x
Rescue Boat Davits, Lifting Hooks and Winches

Davits to be lubricated (Ensure that the grease nipples are not painted) 2/1/2008 x x x x x x
Winches to be lubricated. Check gearbox oil level. 2/1/2008 x x x x x x
Lowering of life boat to water, disconnect and manoeuvre in the water. 2/1/2008 x x x x x x
Check ladder and lifeline condition. Changing drinking water. 2/1/2008 x x x x x x
Fire and smoke detectors

Check all sensors and if alarm transfered on bridge 2/1/2008 x x x x x x
Annually
Liferafts- & Hydrostatic Releases
Send life rafts & associated hydrost. release units to an approved service station for annual survey 2/1/2008 x x x x x x
Check marked lable & validity after shore inspection & delivered documents 2/1/2008 x x x x x x
Breathing Apparatus (compr. air equipment)

Complete BA will be checked by an authorized service on shore (recorded in the ships log book) 2/1/2008 x x x x x x
Test certificate will delivered back on board and BA´s should be labelled and stamped by service 2/1/2008 x x x x x x
Fire Extinguisher (service)

Periodical service of all dry powder, CO2 and foam extinguishers by an authorized shore service 2/1/2008 x x x x x x
Checking of each extinguisher for weight of CO2 cylinders,quality of powder 2/1/2008 x x x x x x
Full report of all checked & labeled extinguishers on board acc.LSA-plan to be kept on board 2/1/2008 x x x x x x
Check completeness after shore service, contents acc.LSA-plan incl.proofed spare capacity 2/1/2008 x x x x x x
Medicine chest & medicine cabinet (service)

Shore based examination (pharmacy) of medicine locker and cabinets if compulsary 2/1/2008 x x x x x x
Replenishment of all used medicine incl. check & refill, if necessary, of life boats first aid kids 2/1/2008 x x x x x x
New Medical Certificate issued with new date of expiry by habour pharmacy for ships docs on board 2/1/2008 x x x x x x
EPIRB / Radar Transponder

Self test on EPIRB shall be carried out without trans-mitting emergency signal
Battery test is compulsory, check labelled validity of hydrostatic release 2/1/2008 x x x x x x
Radartransponder- general condition check 2/1/2008 x x x x x x
Radartransponder-battery check- neccessary exchange is to filed in ship's log book 2/1/2008 x x x x x x
Fire hoses
Check all hoses at 6 ATM water pressure 2/1/2008 x x x x x x
18 Months
EPIRB general condition check 2/1/2008 x x x x x x
MOB signal - replacing of batteries 2/1/2008 x x x x x x
SART general condition check 2/1/2008 x x x x x x
30 Months
Turn falls end for end
5 Years
Lifeboat - renew falls (after 4 years if not turned at 30 months). Gear wheel and brake of lifeboats lifting
mechanisms to be inspected. 2/1/2008
Hydrostatic pressure test to all dry chemicals and foam extinguishers. 2/1/2008
Test of fixed fire extinguishing system CO2. 2/1/2008

FORM Q 02
MARSIG mbH
Lashing equipment inventory

Quantity on Req. Previous Damage
NAME Model N. Delivered Lossed
board Quantity Inventory Report
Deck
Twistlock TL-GL/L 440 464 22 420 2
Twistlock TL-A/L 680 728 0
Midlock TL-M/L 700 704 0
Turnbuckle RS-FS 286 286 0
Lashing Bar R-KS/2470 200 210 0
Lashing Bar R-KS/4950 64 0
Lashing Bar R-KS/4800/R 12 0
Spanner OT-RS/F 20 0
Emergency
OT-E/A/F 2 0
Tool
Operating
OR-A/10370 3 0
Rod
Operating
OR-A/1800 2 0
Rod
Operating
OR-A/4720 2 0
Rod
Operating
OR-F/3800 2 0
Rod
Bin Rack PL-20X8/10 1 0

BIN
Storage Bin 1075X1075X7 4 0
80
BIN
80
Hold 0
Single
IS-1/115 132 0
Stacker
Twist
IS-1T/L 544 0
Stacker
BIN
80
Remarks:

Form Q 03
MARSIG mbH Maintenance of
Security Equipment

Back
Security Equipment Maintenance Job Pice Mar June Sep Dec

(Location)
Hoses check of operational condition acc. Safety Plan x
Axes acc. Safety Plan complete and useable acc. Safety Plan x
Plasticuffs available adequate x
Torches Battery-check, function test at least 6 pcs 8
Walkie Talkies Battery-check, function test at least 4 pcs 5
Deck lighting Bridge In operational condition 2 pcs 2
Deck lighting mast aft In operational condition 2 pcs 2
Deck lighting mast forward In operational condition 1 pc 1
Deck lighting walk ways In operational condition adequate x
Searchlight Rescue Boat In operational condition 1 pc 1
Searchlight Monkey Island In operational condition 1 pc 1
Portable Searchlights In operational condition 2 with 1 KW 2
Others:
Maintenance details / deficiencies remarks:
Signature SSO:
Revision: 01.01.2008 Approved by CSO Page 27 of 81

Form Q 03
MARSIG mbH Maintenance of
Security Equipment

FORM Form Q 04
MARSIG mbH
Summary of Tank Inspections

Back Vessel: FSO Surya Putra Jaya Year: 2014
CONDITION
G=GOOD / F=FAIR / R=RUSTY IN % / A=ACTION CARRIED OUT / L=LEAK FROM APC / D=SHELL INTERNAL DAMAGE
SENSOR CONDITION
W = WORKING / NW = NOT WORKING
COMPARTMENT 1.INSP. / No. # 1.INSP. / No. # 1.INSP. / No. # 1.INSP. / No. #

2008 2009 2010 2011
FOREPEAK 18-Jan-03 W G 26-Feb-04 W G 11-Jun-05 W G
NO.1 DB TANK 12-Feb-03 W G 21-Oct-04 W G W
NO.1 A PS SIDE TANK 13-Apr-03 W G 23-May-04 W G 30-Apr-05 W G
NO.1 A SB SIDE TANK 13-Apr-03 W G 23-May-04 W G 30-Apr-05 W G
NO.1 C DEEP TANK 13-Apr-03 W G 8-Jun-04 W G 22-Jul-05 W
NO.2 PS DB TANK 24-May-03 NW G 22-May-04 W G 27-May-05 W G
NO.2 SB DB TANK 24-May-03 NW G 22-May-04 W G 27-May-05 W G
NO.2 A PS SIDE TANK 18-Jul-03 W G 30-Sep-04 W G 16-Sep-05 W G
NO.2 A SB SIDE TANK 18-Jul-03 W G 30-Sep-04 W G 16-Sep-05 W G
NO.3 A PS SIDE TANK 11-Nov-03 W G 28-Dec-04 W G W
NO.3 A SB SIDE TANK 11-Nov-03 W G 28-Dec-04 W G W
NO. 3 CL DB TANK W 11-Nov-04 NW G W
NO. 3 PS DB TANK 17-Mar-03 W G 16-Jul-04 W G 23-Mar-05 W G
NO.3 SB DB TANK 17-Mar-03 NW G 16-Jul-04 W G 23-Mar-05 W G
NO.4 A PS SIDE TANK W 8-Dec-04 W G 23-Jul-05 NW G
NO.4 A SB SIDE TANK W 8-Dec-04 W G W
NO.4 C PS DEEP TANK 15-Apr-03 W G 5-Aug-04 W G 19-Aug-05 W G
NO.4 C SB DEEP TANK 15-Apr-03 W G 5-Aug-04 W G 19-Aug-05 W G
NO.4 CL DB TANK 4-Sep-03 W G 20-Oct-04 W G W
NO.4 PS DB TANK 29-May-03 W G 19-Oct-04 W G W
NO.4 SB DB TANK 29-May-03 W G 19-Oct-04 NW G W
NO.5 A PS SIDE TANK 17-Mar-03 W G 16-Jan-04 W G 28-Feb-05 W G
NO.5 A SB SIDE TANK W 16-Jan-04 W G 28-Feb-05 W G
NO.5 CL DB TANK 24-Jul-03 W G 10-Nov-04 W G W
AFTER PEAK TANK 19-Dec-03 W G 28-Sep-04 W G 6-Jul-05 W G
FW TANK NO. 40 24-Mar-03 W G 9-Dec-04 N/A G 11-Aug-05 N/A G
FW TANK NO. 41 22-Sep-03 W G 7-Feb-04 N/A G 10-Jan-05 N/A G
** THE REMAINING TANKS WILL BE INSPECTED AT NEXT POSSIBLE OPPORTUNITY
23.07.05: Port side heeling Tank sensor replaced by another type which read double of the actual sndg.
Req'n sent for same type
3 DB SB SENSOR REPLACED ON 01.11.04
2 DB P&S SENSOR REPLACED ON 08.11.04
3 CL DB SENSOR REPLACED ON 10.03.05 Chief Mate / Chief Engineer

FORM Form Q 04
MARSIG mbH
4DB SB SENSOR REPLACED ON 11.03.05

FORM Form Q 04
MARSIG mbH
NSP. / No. #
2011

FORM Form Q 04
MARSIG mbH

Form F 01
MARSIG mbH
IMO Crew List
IMO CREW LIST

Back
Page
Arrival Departure
1. Name of Ship: 2. Port of arrival / departure 3. Date of arrival / departure
FSO Surya Putra Jaya Oyong Terminal Oyong Terminal 01/01/2014 31/12/2014
4. Nationality of Ship: 5. Port arrived from/port of destination
6. Idendity document / seaman's
Batam Oyong Terminal passport
Indonesia
7./8. Family name, given names 9. Rank or rating 10. Nationality 11. Date & place of birth Seamen'S Book Place of Issue
Mustermann Wilfried Master German
Meier
Willi
Anton AB

Form F 02
MARSIG mbH
IMO Passenger List
IMO PASSENGER LIST

Back
Arrival Departure Page

1. Name of Ship: 2. Port of arrival / departure 3. Date of arrival / departure
FSO Surya Putra Jaya Oyong Terminal Oyong Terminal 01/01/2014 31/12/2014
4. Nationality of Ship:
Indonesia
5. Family name, given names 6. Nationality 7. Date & plae of birth 8. Port of embarkation 9. Port of disembarkation
Meier
Müller
Date and signature by master, authorized agent or officer

Form F 03
MARSIG mbH
Ship's Stores Declaration
THE DEPARTMENT OF THE TREASURY

BUREAU OF CUSTOMS
SHIP'S STORES DECLARATION

Back
X Arrival Departure Page No.
1. Name of ship: FSO Surya Putra Jaya 2. Port of arrival/departure: 3. Date of arrival/departure:
Oyong Terminal Oyong Terminal 01/01/2014 31/12/2014
4. Nationality of ship: Indonesia 5. Port arrived from/Port of destination: Batam Oyong Terminal
6. Number of persons on board 0 7. Period of stay 365 8. Place of storage *
9. Name of article 10. Quantity 11. For Offical Use
DECK
Ammunition, 38 cal. NIL Rds.
Revolver, 38 cal. NIL Ea.
Rope, Fiber 4 Ft.
Rope, Wire 4 Ft.
ENGINE
Diesel Oil 33536 Gal s.
Fuel Oil 7865 Bbl s.
Fresh Water 45 Tons
Lube Oil 16543 Gal s.
STEWARD
Cereal & Paste 0 Lbs.
Coffee 0 Lbs.
Dairy 0 Lbs.
Eggs 0 Doz.
Fish Frozen - Fresh & Salt 0 Lbs.
Fruit Fresh - Dried & Canned 0 Lbs.
Meat Fresh - Canned & Salt 0 Lbs.
Poultry 0 Lbs.
Vegetables Fresh - Frozen & Canned 0 Lbs.
Sugar 0 Lbs.
GENERAL
Detergents & Soap 49 Lbs.
Grease 176 Lbs.
Kerosene & Solvent 37 Gal s.
Paint 343 Gal s.
Paint, Additives 79 Gal s.
BONDED
Beer 0 Cases
Cigarettes 0 Ctns.
Cigars 0 Ea.
Gin 0 Btl s.
Liquers 0 Btl s.
Tobacco 0 Lbs.
Whiskey 0 Btl s.
Wine 0 Btl s.
Softdrinks 0 Cases
Sparkling Wine 0 Btl s.
Rum 0 Btl s.
NARCOTICS
Codeine Sulfate gr. 0 Tablet
Morphine Sulfate gr. 0 Tubex
Paragoric 0 Pints
Phenobarbital gr. 0 Tablet
Also such broken and sundry stores as linen, crockery, silver, spare parts, tools, instrument hospital
supplies and slop chest stores as required by law and/or necessary for the safe and efficientnavigation and operation of the vessel.
12. Date and signature by master, authorized agent or officer 4/11/2018
* Not required by the United States

Form F 04
MARSIG mbH
Crew's Effects Declaration
THE DEPARTMENT OF THE TREASURY
BUREAU OF CUSTOMS
SHIP'S STORES DECLARATION

Back
X Arrival Departure
Page No.
MV FSO Surya Putra Jaya 7. No. of crew Declaration of

2. Articles acquired abroad by officers and members of the crew (except
members's articles (if
3. Nationality of ship Indonesia those exclusively for use on voyage or cleared through Customs
intended to be none, show
authorities)
landed "None")
4.No. 5. Family name, given names 6. Rank
Cigarettes
Others
Tabak
Spirit
1 Mustermann Wilfried Master 200 NIL 1 Laptop, Camera
2 Meier
3 Willi
4
5
6
7
8
9
10
11
12
13
14
15
16
17 Anton AB
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
9. Date and signature by master, authorized agent or officer 4/11/2018

Form F 05 IMO
MARSIG mbH
General Declaration
Back IMO SHIP'S STORES DECLARATION
Arrival Departure
1. Name and description of ship: FSO Surya Putra Jaya 2. Port of arrival / departure 3. Date/time of
Oyong Terminal arr/dep
Oyong Termin01/01/2014 31/12/2014
4. Nationality of Ship: 5. Name of Master 6. Port arrived from / port of destination
Indonesia Ihwan Asrul Batam Oyong Terminal
7. Certificate of registry (port: date: number) 8. Place of storage
9. Gross tonnage 10. Net tonnage
25808 5300
11. Position of the ship in the port (berth or station)
12. Brief particulars of voyage (previous and subsequent ports of call; underline where remaining cargo will be discharged)
13. Brief description of the cargo
14. Number of crew (incl. master) 15. Numbers of passengers 16. Remarks
4 2
Attached documents (indicate number of copies)
17. Cargo declaration 18. Ship´s stores declaration
19. Crew list 20. Passager list 21. Date and signature by master, authorised
agent or officer
22. Crews effects declaration ( * ) 23. Maritime declaration of helth ( * )
For official use:
(*) only on arrival

Form F 06
MARSIG mbH
Vaccination List
Back VACCINATION LIST

Name of ship: FSO Surya Putra Jaya Date of arrival: 01/01/2014 Port arrived from: Batam
Nationality of ship: Indonesia Port of arrival: Oyong Termi Date of expiry
No. Family name, given names Rank Nationality Cholera Yellow Fever
1 Mustermann Wilfried Master German
2 Meier
3 Willi
4
5
6
7
8
9
10
11
12
13
14
15
16
17 Anton AB
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
Date and signature by master, authorized agent or officer 4/11/2018

Form F 07 IMO
MARSIG mbH
Declaration of Health
IMO DECLARATION OF HEALTH

Back
Port of: Oyong Terminal Date: 11/04/2018

Name of ship: FSO Surya Putra Jaya From: Batam To: Oyong Terminal
Nationality: Indonesia Master’s name: Ihwan Asrul
Net registered tonnage: 5530
Deratting or Certificate: Dated:
Deratting Exemption Issued at:
No. of Cabin: No. of crew: 0
passengers Deck: 0
List of ports of call from commencement of voyage with dates of departure:
HEALTH QUESTIONS Answer

YES or NO
1. Has there been on board during the voyage* any case or suspected case of plague, cholera or yellow fever?
Give particulars in the Schedule. ✘
2. Has plague occurred or been suspected among the rats or mice on board during the voyage* or has there
been an abnormal mortality among them? ✘
3. Has any person died on board during the voyage* other than as a result of accident? Give particulars in the
Schedule. ✘
4. Is there on board or has there been during the voyage* any case of disease which you suspect to be of an
infectious nature? Give particulars in the Schedule. ✘
5. Is there any sick person on board now? Give particulars in the Schedule.
Note: In the absence of a surgeon, the Master should regard the following symptoms as grounds for ✘
suspecting the existence of disease of an infectious nature: fever accompanied by prostration or
persisting for several days, or attended with glandular swelling; or any acute skin rash or eruption with or
without fever; severe diarrhoea with symptoms of collapse; jaundice accompanied by fever.
6. Are you aware of any other conditions on board which may lead to infection or the spread of disease?
✘
I hereby declare that the particulars and answers to the questions given in this Declaration of Health (including the Schedule) are
true and correct to the best of my knowledge and belief.
Signed (Master) Ihwan Asrul
Countersigned (Ship’s Surgeon)
Date:
* If more than four weeks have lapsed since the voyage began, it will suffice to give particulars for the last four weeks.

Form F 09 (Schedule)
MARSIG mbH Declaration of Health
Schedule
IMO DECLARATION OF HEALTH

Back
Name Class or rating Age Sex Nationality Port of embarkation Date of embarkation Nature of illness Date of its onset Results of illness* Disposal of case**
*State whether recovered, still ill, died.

**State whether still on board, landed at (give name of port), buried at sea.

Form O 01
MARSIG mbH
Ship Certificates
MV: Master 1 Year: 2008

Back
Master: Quarter: January
Date of Issue/ Kind of
No. Certificates issued by Total validity Renewal Date Remarks
Endorsement survey
Periodical Certificates
CERTIFICATE OF NATIONALITY Ditjen Perla
Buku pengesahan Nakhoda Ditjen Perla 0,5 DUE
INTERNATIONAL LOAD LINES 1966 NK 1 DUE
INTERNATIONAL LOAD LINES 1966 (sementara) BKI 1 DUE
CERTIFICATE OF CLASS NK 0,5 DUE
PROVISIONAL CLASSIFICATION CERTIFICATE (sementara) BKI 1 DUE
CERTIFICATE MACHINARY BKI 1 DUE
CERTIFICATE of Hull BKI 1 DUE
CERTIFICATE OF INSTALATIONS REGISTRATION NK 1 DUE
CARGO SHIP SAFETY CONSTRUCTION CERT. Ditjen Perla 1 DUE
CARGO SHIP SAFETY EQUIPMENT CERT. Ditjen Perla 1 DUE
CARGO SHIP SAFETY RADIO CERT. Ditjen Perla 1 DUE
INTERNATIONAL TONNAGE (1969) Ditjen Perla 1 DUE
IOPP CERTIFICATE + SUPPLEMENT Ditjen Perla
CIVIL LIABILITY CERT. (C L C ) Ditjen Perla
D O C (copy) Ditjen Perla 3 DUE
S M C (Safety Management Certificate) Ditjen Perla 2 DUE
INTERNATIONAL SHIP SECURITY CERTIFICATE. Ditjen Perla 2* / 1 DUE
SHIP STATION LICENCE + LRIT Ditjen Postel 2 DUE
SAFE MANNING CERTIFICATE Ditjen Perla 2 DUE
SK SUSUNAN PERWIRA Ditjen Perla 2 DUE
BUKU SIJIL ADA 5*/ 2/ 2+1** DUE
Fire Extinguisher Cert. Batam M Indo 2/2 DUE Bare boat only
ILR (Inflatable Life Raft) Batam M Indo 5/ 2/ Perm DUE
Foam Analisis Report Batam M Indo 2 DUE
Halon Certificate (Fix) Batam M Indo 5 / R DUE
Berita Acara Penggantian Bendera KBRI S'pore 2.5 DUE
Berita acara Penyerahan Dokumen KBRI S'pore 3/3 DUE
GMDSS SHORE-BASED MAINTENANCE Jason Elektr.
PNI / CERTIFICATE OF ENTRY PNI 5 / R DUE
PNI+Ditjen 5 / R DUE
Bunker Convention Cert + Spesifikasi Kapal Perla
BUKU KESEHATAN Port Health Off 5 / R DUE
Derating Exemption Cert. Batam 2.5 DUE
SHIP SECURITY OFFICER CERTIFICATE (copy) Ditjer Perla 1 DUE
CONTINOUS SYPNOPSIS RECORD (C S R) 5 / R DUE
Permanent Certificates Place issued Issued by Cert. ID Remarks

Registry
International Tonnage Certificate
Suez C. Tonnage & Ship’s Register Number
Panama Tonnage
SOPEP
Cargo Securing Manual
Trim & Stability Booklet
Certificate of Compliance ILO and ILC
Approval of Ship Security Plan
Continious Synopsis Record (CSR)
Signature Of Master Date & Stamp

FORM O 02
MARSIG mbH
Master Review

Agenda:
Master has to prepare from time to time a written report to judge the SMS
during his stay on board.Half-yearly written report is possible and/or if
master is changing the command. During Internal and External Audits on board
as well as verification of reports by the office staff it came up that Master’s
SMS Review (according to the concerned Form) are filled out impracticably or not
sufficiently. Improving proposals or ideas concerning SMS are welcome to the Company
and DP.
Following topics of content are given to bring this Review in an acceptable style,
so that Authorities, Auditors and Company’s Management are able to read the Status
of Safety Management on Board .
Note: The text in the Standard Form is an example only and does not cover the entire
SMS verification as to be concerned.
Topics of Master’s Review:

(Do not list all positive items, give general overview or list negative occurrences
if so! If some important positions have to be considered, give additional remarks
to relevant reports or forms! Do verify the time since the last Master’s Review only!)
-General Statement
Please state that the SMS is implemented and maintained as per ISM –Code and as per
Company’s System described in the ISM-documentation. Mention out that environmental
protection is considered accordingly.
-Condition of Crew
Please inform the company about condition of certificates, condition of safety training,
working behaviour and covering of rest time regulation...
-Accidents and serious occurrences

Give a summary if accidents are happened (or nearby happened). Give information about
follow up verification.
-Internal and External Audits / PSC / Important Surveys

Give an Overview about Audits, Port State Control or Surveys, appearing major deficiencies
and status of clearance since last review.
-Condition of Machinery and Equipment

Please inform the Company about general status of machinery and equipment (maintenance).
If there is a permanent problem, please mention it.
-Improvement of SMS
If there are some proposals for improvement of SMS, please give recommendations for operation,
changing of manuals, procedures, forms a.s.o. Do it in a positive and useful way to help us
figuring out how to react.
Signature Master:

Form O 03
MARSIG mbH
NC Report
Back
Vessel: Master: Date:

Incident: Accident: Near Miss: Non Conformity: Critical Equipment Failure:
A Incident (to be described by master)
B Corrective Action (to be defind by DPA)
C Preventive Action (to be defind by DPA)
Date of Implemention on board:

(Signature by master)
Date of Completion of Implementation:

(Signature by master)
Revision: 01.01.2008 Approved DP Page 3 of 81

Form O 05
MARSIG mbH
Requisition List
Back REQUISITION FOR SPARE PARTS

DATE NO Reference NO Deck Eng
10/27/2008 E-2008-01-01 x
Incoming Order: Envelope Phone Fax
Name of Vessel:
Name of Machinery: xxx
Type: xxx
Serial No:
Maker: xxx
Address:
Part Description Part No. Drawing No ROB REQ
Remarks:
PLEASE FORWARD TO : Klingenberg Bereederungs- und Befrachtungs OHG

ADDRESS : After de Höf, 20459 Hamburg, Germany

Form O 06
MARSIG mbH
Container Damages
Voyage No.: 01/14 MV: FSO Surya Putra Jaya Year: 2014
CONTAINER INTERCHANGE RECEIPT AND DAMAGE REPORT
CONTAINER - No: 234444444444
This container received in apparent good order except as noted. This interchange is made subject to the terms and conditions
of the currently effective interchange contract between J. Kahrs
Bereederung GmbH & Co. KG and:
Questo container ricevuto in apparente buona condizione quanto indicato. Questo scambio e regolato dai termini e condizioni del contratto di scambio
attualmente in vigore tra il J. Kahrs Bereederung GmbH & Co. KG e:
Este container recibido en buenas condiciones salvo lo que se indica. Este intercambio se hace sujeto a los terminos y condiciones del
contrato de intercambio actualmante en vigencia entre el Transportador
J. Kahrs Bereederung GmbH & Co. KG y:
Ce container est reçu en bonne condition sauf pour les exceptions indiquees. Cet echange est effectue sous reserve des termes et conditions du contrat
d echance actuellement en vigueur entre le Transporteur Destinataire et:
1) TAKEN FROM TERMINAL: Eurokai 2) RETURNED TO TERMINAL: hugiluhlkjio

Full-Seal No: 3333333 Full-Seal No: 333333333
Empty Empty
RAİN TOP BOTTOM SIDE RAIL TOP 12)

OUTER
RIGHT SIDE
HINGES CORNER
CASTING
LOCK REAR BOTTOM
LATCH RAIL SIDE POSTS
LOCKING IF FITTED Seal missing
LOCKING HANDLE FRONT LEFT
BAR-HINGE TOP SIDE FRONT
LOCKING LEFT RAIL
BAR CORNER SIDE LEFT
POST SIDE
ENGLISH ITALIAN SPANISH FRENCH

1) Scratch Graffio Rascadura Egratignure
2) Cut Taglio Corte Entaille
3) Gash Squarcio Desgarro Dechirure
4) Hole Buco Hueco Trou
5) Deep score Graffio profondo Rescadura profunda Egratignure profonde
6) Punctured Bucato Horadado Perce
7) Broken Rotto Rompido Casse
8) Distorted Contorto Torcido Tordu
9) Bent Piegato Encorvado Plie
10) Ripped Strappato Lacerado Arrache
11) Dent Ammaccato Magullado Froisse
12) Pushed in Ammaccatura rientrante magullado entrante Degat concave
13) Pushed out Ammaccatura sporgente magullado saliente Degat convexe
14) Caved in Sfondato Hundido Enfonce
15) Missing Mancante Falta Manquant
For receiving party : For delivering party :

Form O 06
MARSIG mbH
Container Damages
DATE : 4/11/2018 PLACE: DATE : 4/11/2018 PLACE:

Form O 07
MARSIG mbH
Stevedore Damage Report

Call Sign: PNRP Flag: Indonesia
MV: FSO Surya Putra Jaya To: Head Office 'Fleet Management'
Charterer: CMA / CGM Report No: 37 / 2006
DAMAGE REPORT
Notice of damage to ship or her fittings by stevedores or other charterer's servants
To Messrs.
Stevedores Company / Local Charterers Agent
Port: Date: Voyage:
Herewith the undersigned, Master of the MV Indonesia declared that the damage to ship and/or gear and/or
equipment as stated herunder, was caused by the stevedore's personnel, whilst handling cargo during the stay of the vessel
in the above mentioned port.
Date/time
Description of damage Cause of damage
of damage
18-May-2005 Midlock TL-M/L damaged / lost 4 During cargo operations (unlashing, discharging, loading)
due of negligence of stevedores.
Turnbuckle RS-FS badly dent / damaged 1 During cargo operations (unlashing, discharging, loading)
Twist stacker IS1T/ damaged / lost 1 During cargo operations (unlashing, discharging, loading)
The damage is in no way caused by any fault in ship's management during loading and/or unloading operation, but solely is
owing to the activities of the stevedores personnel.
The Master of the vessel herewith holds the above company responsible for all consequences arising from of the above
stated damages.
……………………………… ..................................... ...........……………..........…

Chief Officer / Duty Officer Master For the agency/stevedores
Agent has been informed.
Remarks concerning repairs: Above stated damages cannot be repaired by ship's crew.
Remarks by Master/Stevedores:

FORM O 08
MARSIG mbH Summary ship dammages

DR Port Description of damage, Name of company, caused damages. Amount Amount Projex Repaired /
Date Number HAS TO BE FILLED OUT CONTNIUOUSLY !! D/N Status
€ $ Replaced by
01/02/08 xx yy CASSAR closed
01/02/08 xx yy open

FORM O 08

FORM O 08

FORM O 09
MARSIG mbH
Voyage Planning
Passage Plan for Congested Waters

Back
from: Oyong Terminal to: Oyong Terminal MV: FSO Surya Putra Jaya Call Sign: PNRP
Signature
Master: Ihwan Asrul Track: Rhumb line ✘ Great circle Comp. great circle
C/O: Position fixing mode:
2nd O: DGPS Radar:
C/E confirmation for sufficient bunker, FW & lub oil Charterer's speed requirement: kts
C/E: Use of weather routeing: Yes No ✘ By Whom:
Special notes:
Waypoint Latitude Longitude True course Track distance Radar marks Parallel index Frequency VHF Track error
Rad. E.ch. degrees n miles name PL PL No.1 No.2 minutes rep. channel max allowed
0 53 34.63 N 8 32.18 E 5 0.1NM

FORM O 09
MARSIG mbH
Voyage Planning
Books required for passage: Example

Charts used on passage: 1111 2222 3333 4444

FORM O 09
MARSIG mbH
Voyage Planning
Tidal information
Area High water Low water Total passage distance: 123 nm
Dangerous or Anchorage Necessary for

Safe speed Remarks
cautions areas (plan & emergency) VHF Reports

Form O 10
MARSIG mbH
Tank Report
MV: FSO Surya Putra Jaya

Back Master: Ihwan Asrul Date: 4/11/2018
Report No.: # 50
TANK REPORT
TANK / NO. / TYPE : Double Bottom Tank 5 Port
Surveyed by : Bosun
Check List enclosed space

entry observed : YES
Survey date :
GENERAL CONDITION
Paint Condition : PAINT WITHOUT ANY DEFICIENCY
Corrosion : NO
Mechanical Damages : NO
Sediment & Residual Water : 20 cm
PARTIAL CONDITION
Deairation Pipes : GOOD
Ballast Pipes / Flanges &

Suction Pipe : GOOD
Tankladders : Partly sign of corrosion
Manhole Covers / Bolts / Packing: Tankside full rusty covered with white Fluid Film
Remote Control Valve of Tank : N/A
Pipe Holders : OK
Foreign Bodies : NO
Heating Coils : N/A
Other Remark : Pipe compensators OK
Attached Pictures : DC001-Bottom; DC002-Flatbars from pipe supports; DC003-Coating

DC004-scallops bottom;
Attached Drawing / Sketch : 1) Tank sketch with corroded areas

Form O 10
MARSIG mbH
Tank Report
Name & Signature:

Form O 11
MARSIG mbH
Tank Report

Back Master: Ihwan Asrul Date of arrival: 01/01/2014
PORT STAY EMERGENCY LIST

FOR ADDRESSES OF CLASS AND P&I CLUB SEE ALSO ADDRESS-LIST
TELEPHONE
MOBILE PHONE /
AGENT FULL STYLE Office hours After FAX TLX
VHF CHANNEL
Office hrs.
CHINA SHIPPING NORTH

AMERICA AGENCY
111 WEST OCEAN BLVD,
SUIT 1700
LONG BEACH CA 90802
PILOTS
FIRST AID
FIRE BRIGADE
AMBULANCE/HOSPITAL
PORT AUTHORITY
POLLUTION CONTROL
GATE
POLICE
STEVEDORES
AMBASSY
CLASS SOCIETY
P&I CLUB

Place: Oyong Terminal
Date:
Chief Officer Master

Form O 12
MARSIG mbH
Notice of Readiness
MV: FSO Surya Putra Jaya Year: January

Back
Master: Voyage No Month: Oyong Terminal
Notice of Readiness
Marsig mbH
Fischerweg 408, 18069 Rostock
Please note that the ship: FSO Surya Putra Jaya
Nationality: Indonesia Call Sign PNRP arrived under my command
at the port: Oyong Terminal
anchored in the roadstead of: Shanghai Bay on: 1/12/2008
at: 12:00 p.m.
waiting for a loading / discharging berth
and is ready in every respect to commence loading / discharging cargo of:
in accordance with the terms, supplements, deletions and exceptions of the

Charter Party dated as agreed.
If it is intended to commence loading / discharging the cargo earlier thannamed

in the Charter Party time is to count from the time of actual beginning.
Place: Shanghai
Date: 5/12/2006 Hour: 12 p.m.
Charterer:
Master:

Form O 12
MARSIG mbH
Notice of Readiness

Form C 01
MARSIG mbH
Arrival Deck

Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Novorossiysk
Novorossisyk
O Back
Marsaxlokk
Constanta
Constanta
R
Trabzon
Istanbul
Odessa
Odessa
Cagliari
Piraeus
T
Varna
S
Poti
Poti
To be filled in by the Duty Officer:
Info to engine department about ETA approx. EOSP and expected first
1 manoeuvre x
2 Check up following equipment and instruments: x
Electronical navigational aids x
Radars set up and tuned x
Radios, Walky-Talkies, Intercom x
Primary & emergency navigation lights and signals, sound signal eq x

Steering gear x
Indicators for rudder, engine revolutions x
Mooring ropes and necessary equipment on
3 stations prepared x
Anchoring equipment prepared, both anchors ready
4 for let go x
5 Navigational flags and lights exhibited x
Approaching cond as depths, shoals, tidal cond, anchorage and prohibited
6 areas checked x
7 Comm channels of pilots/port authorities noted in naut charts x
8 Latest weather reports and navigational messages available x
9 Pilot ladder prepared acc to pilots advice (incl. lighting) x
To be filled in by the Master: x
10 Inward clearance formalities prepared x
Arrival and port req. given by agents and published. Admiralty List of
11 Radio Signals checked
12 Specific regulations (if any) of the Company for this port checked x
13 Information to Chief Engineer about fixed EOSP
Established VHF contact to VTS, port authorities and pilots according
14 specified port regulations
Update of ETA given by radio communications to pilots, agents and
15 authorities
16 Checked up navigational conditions as prepared by Duty Officer
17 Crew on deck and in engine on stand by for mooring manoeuvres
18 Bridge manned with helmsman
19 Filling out of this check list recorded and signed in log book

Form C 01
MARSIG mbH
Arrival Deck
Signed by the Master Signed by the Duty Officer

Form C 01
MARSIG mbH
Arrival Deck
31
Varna

Form C 02
MARSIG mbH
Departure Deck

Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
P
Novorossiysk
Novorossisyk
O Back
Marsaxlokk
Constanta
Constanta
R
Trabzon
Istanbul
Odessa
Odessa
Piraeus
Cagliari
T
Varna
Varna
Poti
Poti
S
1 Binoculars, Sextants, bearing diopters available

Gyro Compass and repeaters running
2 /synchronized
Magnetic bearing and steering compasses
available, repeaters synchronised, course
3 compared
Echosounder / echograph switched on and
4 checked
5 Electronic nav. aids available
Radio communication components complete
according to SOLAS requirements switched on
6 and working in satisfactory condition
7 General alarm tested
Bridge communications equipment (Intercom,
8 portable VHF) tested
Latest weather report / actual weather chart
9 available for assessment
Charts, flags, nautical publications updated and
10 prepared for next part of the voyage
x
11 Sound signal equipment tested

x
12 Primary and emergency navigation lights checked

13 Checked for drug smuggling and stowaways
14 Ship's clocks compared, synchronised
Signalling lamps and emergency ligthing tested,
15 available
Actual and computed draughts recorded, draughts
16 within permissible limits
Stability/reserve buoyancy attained with due
consideration of stability criteria (seaway
17 condition)
18 Course- and engine movement recorder available
19 Propeller and rudder clear for visible obstructions

20 Radar(s) set up, tuned and ready for operation
21 Cargo secured according Cargo Securing Manual,

22 Hatches properly secured for sea
IMDG cargo stowed / segregated according IMDG
23 Code
Holds, hull and store openings properly closed
and secured, ventilation flaps on forecastle and
24 main deck watertight closed (if applicable)
25 Whistle, signalling equipment tested
Windows wipers (heating), clear view screens
26 tested, available
Loading completed according loading plan, cargo

27 operations completed recorded in log book
Cargo documents as B/L, Manifests, Master
Stowage Plan, IMDG cargo documents on board
28 (if applicable)
Documents and clearances for sailing obtained
from the appropriate authorities, ship’s certificates
29 on board
30 Crew completed and healthy as per safe manning

Fuel, diesel and lub oils in sufficient quantity and
31 instructed quality on board
Main engines ready, telegraphes and remote
32 controls tested
Anchors and chains reported free of visible
33 obstructions and ready to let go
34 Smoke- and gas detecting device tested, available

Indicators for rpm, pitch rudder working (if
35 applicable)
Engine running on zero pitch with manoeuvring
36 speed
Bow thruster pump & motor working, switched to
37 wing control
38 Steering gear working, switched to wing control

39 Pitch controller switched to wing control
Main- and emergency- and aut steering, change
over arrangement, rudder indicator tested and
40 available, reversing indicator switched on
Signed by the Master Signed by the Duty Officer

Form C 03
MARSIG mbH
Crew Familiarization

Name: Last vessel, type / size:.
Rank: Ex – Crew of this vessel ? date last sign off :
responsibility to ensure that the new employee is immediately familiarised and briefed about the following:
1. Crew member’s cabin, assigned life boat, location of life jacket and immersion suits, nearest fire extinguisher
and other fire-fighting equipment, escape routes, safety plan and any other personal life saving appliances
specific to the vessel
2. All on-board safety information symbols, signs, alarms, signals
3. Personnel procedures for “Man Overboard“
4. Immediate actions upon detection of fire or smoke, raising of alarms
5. Actions after hearing “Abandon Ship“ or “General Alarm“
6. All locations of muster stations, station bills and its content
7. Special duties assigned in case of life boat launching
8. Demonstration of vessel’s internal communication system
9. Assignment of station during mooring and un-mooring
10. Familiarisation tour through vessel (deck, engine, accommodation)
11. Introduction of new employee to all crew members
12. Instruction in the drug & alcohol policy
13. Location of company’s safety manuals and standing orders for all officers
14. Check of crew member’s safety working clothes / uniform - by Master
15. Duties and responsibilities concerning Safety and Security on board
16. Duties and responsibilities according rank, safety and security system
17. Specific items for deck officers and crew:
-Cargo handling equipment
-Cargo safety arrangements, cargo related safe working practices
-Company safety requirements during loading / discharging
-Dangerous cargo safety precautions
-Handling and maintenance of deck plants and facilities to fulfil the duties or agreed time for work in
18. Specific items for engine officers and crew:
-Engine room related safe working practices
-Safety arrangements, repair tools, emergency alarms
-Company safety requirements during assemblings / mountings
-Dangerous substances, chemicals and company's precautions
-Handling and maintenance of engine plants and facilities to fulfil the duties or agreed time for work in
19. Visit of ship, especially working area deck / engine
20. Environmental Protection, the procedure for handling of garbage, rubbish and wastes
21. Function Specific Introduction (state details can provided in blanc space)
I, Ihwan Asrul Master of MV FSO Surya Putra Jaya hereby confirm that the crew member has
been fully briefed and familiarised in all the above issues and I will ensure that he/they will be further trained
in accordance with company’s quality, security and safety management
Today 11/04/2018 port of Oyong TerminaMr. Muster was familliarized on board the vessel.
Designated officer brief and explain to him according to familliarization checklist.
Muster, Marten
Signature and name of familiarized crew member

Form C 03
MARSIG mbH

Muster, Marten

Form C 03
MARSIG mbH

Muster, Marten

Form C 03
MARSIG mbH

Muster, Marten

Form C 03
MARSIG mbH

Muster, Marten

Form C 04
MARSIG mbH
Change Over - Master
MV: FSO Surya Putra Jaya Port of Arrival Departure: Oyong Terminal
Back
Voyage No.: 01/14 Date: 4/11/2018
Consumables, ROB in t
HFO: MDO: Luboil: Sludge:
During take over of command following matters have been thoroughly discussed
Desciption Discussed & accepted
Charterer
Trade area(s), WP's, distances, voyage times
Particular conditions in ports of call, circular trade, ports with peculiarities (port
authorities, agents, ship chandler, customs..)
Basic port
Information to reliable / efficient fuel bunkering
Information to reliable / efficient fresh water bunkering
Information to reliable / efficient provision order
Which port for which deliveries
Change of command - Marlow Navigation
Masters Cash Account closed and handed over with following balance
Other messages, reports, dispatches
Cargo, Dangerous Goods, Reefer, Special Containers, Ballast and Stability
information
Inventory and validity of ship's documents / certificates / last class survey
Manoeuvering characteristics of vessel
System ISM, ISPS
Crew qualification, abilities, training status
Crewlist, Crew Certificates
Outstanding Deliveries / Sparepart requirements
Open Ship, FSC, PSC claims and ext./int. NC's
Technical failures, summery of Damage Reports
Outstanding repairs
Recommendations of class
Plan of damages in vessel's hull
Introduction to ship's computers and bridge installations
List of insurance representatives
Last voyage report, next voyage details / planning
Owner’s instructions / circulars
Last Provision stock
Communication Folders (Tlx…)
Vessel inspected (see Remarks)
Engine plants - weaknesses and their trouble shooting
Watch Arrangement / Rest Time acc STCW and Flag Requirements (see M12
'Monthly statement')
Clear and only ONE documentation of working / rest hours on company's form
No M06
Following documents / items received complete and in good order
Desciption Comments
Status of Class- and Flag State Cerificates
Updated list of outstanding orders / repair works
Imprtant correspondence – company
Imprtant correspondence – charterer
Imprtant correspondence – crew manager
Deck log book, oil record book, deviation log book, radio log book
Vessel inspection
Desciption Condition status (1-3)
Bridge/Wheelhouse
Is the navigation equipment such as:
binoculars (2), sextant (2), barometer, chronometer, clocks, stopper, etc.

Form C 04
MARSIG mbH
Nautical charts and publications corrected until?

Is the gyro compass OK?
Echo-sounder operable?
Satellite navigator (GPS) operable?
Watch alarm system operable?
Typhoon signal automate operable?
Navigational lights, Typhoon, Aldis lamp, Hand sound-meter, navigational marks
(balls, cones) operable?
Radar 1 (ARPA)
Radar 2
AIS
SSAS
Scale of pitch of propeller to speed
Behaviour of ship in general
Information to reliable / efficient provision order
Radio Station
Are the GMDSS operators familiar with the eq.?
Are radio - telex and satellite telex operable?
Radio facsimile receiver operable?
VHF 2 pcs operable?
INMARSAT C - set operable?
GMDSS manuals for installed eq. on board
NAVTEX Receiver operable?
Two way walkie talkie min 3pcs operable?
Ship’s intercom operable?
Deck
Pontons, hatch rubbers
Cargo Crane 1 / 2
Anchor windlass condition?
Are there any problems dropping the anchor?
Number and condition of the mooring ropes
Painting of vessel?
Are there any problems with manoeuvring and steering?
Superstructure
Stores
Deck stores
Dispensary
Engine Department - general view
Emergency generator
Steering gear, em. handling
Tanks
Bow thruster
Ship
Stability
Portfacilities and specials for present trade
Loading, unloading activities
Safety, Security conditions , Stowaways
Handing over of:
Key Box, Key procedure, set of Master’s key
Digital camera + equipment (charger, ...)
Mobile telephone + equipment (charger, spare accu, ...)
One set of ship’s plans and drawing with muster-map
Handed over ship’s log book no:
Radio log book no, (with Antigua Telecom instruction
and documentation of vessel’s correspondence)
ISM Manuals

Form C 04
MARSIG mbH
Security Plan
Signature, leaving Master Signature, signing on Master

Form C 05
MARSIG mbH
Welding Work
MV: FSO Surya Putra Jaya Date: 11/04/2018

Back Master: Ihwan Asrul
Work description:
Work location:
Period of validity of the permit (should not exceed 24 hours):

Authorized person in charge of the work:
The From must be filled before every hot work. According to company regulations Chief Officer is responsible for this checklist. He is also
responsible for the hot work done in the engine room. He is authorised to issue the permit together with chief eng
Duration of Period
From: Hrs: Date:

To: Hrs: Date:
SAFETY CHECKS:
Fire equipment made ready
Has the surrounding area been made safe?
Fire watchmen posted / instructed
Communication established between fire watchmen and bridge
Emergency procedures discussed
Has an enclosed space entry permit been issued (If the work is in enclosed space)
Is the equipment isolated electrically
PERSON RESPONSIBLE FOR

HOT WORK Name-Surname/Signature Date and Time
PERSON RESP. FOR SAFETY

Name-Surname/Signature Date and Time
Remark
If work is interrupted for any period exceeding 2 hours , this permit becomes invalid. This permit is only valid in conjunction
with safe entry permits if the work is in enclosed space.
Permit authorised
Chief Engineer
(Signature)
Master
(Signature)
Permit Cancelled by
Chief Engineer
(Signature)
Master
(Signature)
Remarks:

Form C 06
MARSIG mbH
Aloft 6 Outboard work

Work description:
Work location:

PROTECTIVE CLOTHING/SAFETY EQUIPMENT:

1-SAFETY BELTS/CLOTH/HELMET/SHOES/GLOVES
2.GOGLES
3-EAR PROTECTION/ DUST MASK
4.OTHER EQUIPMENT
WORKING ALOFT,OVERSIDE,STAGING OR IN EXPOSED POSITIONS
NEAR THE WHİSTLE: Source of power isolated and warning notice is displayed
ON THE FUNNEL: Engineers informed to limit smoke, soot and steam emission
NEAR THE RT AERIALS: Radio operator informed not to use RT systems
NEAR RADAR AERIAL&SCANNERS: Deck Officer informed and waring notice displayed
VICINITY OF PROPELLERS: Engineers informed and warning notice displayed
Safety harness and lifeline worn (where toe guards and guard rails not fitted)
Life jackets worn (outboard works, when they are permitted)
Staging examinedand properly secured
Containers for tools, to be properly fastened, are provided
VALI. PERIOD
THE ABOVE HAVE BEEN CHECKED AND THE CONDITIONS FOR THE JOB TO BE CARRIED OUT IS CONSIDERED TO BE SAFE UNDER THE
MENTIONED CONDITIONS FOR THE FOLLOWING PERIOD.
From: Hrs: Date:

To: Hrs: Date:
Responsible Officer:
(Signature)
W. OUTHORITY
PERMISSION TO CARRY OUT THE JOB IS GRANTED SUBJECT TO THE CONDITIONS ABOVE.
MASTER/CH.OFF/CH.ENG:
(Signature)
CANCELATION
THE PERMIT IS HEREBY CANCELED, ALL SAFETY PRECOUTIONS FOR THE COMPLATION OF THE JOB HAVE BEEN CARRYED OUT.
N CHARGE:
(Signature)
Remarks:

Form C 07
MARSIG mbH
Enclosed spaces

Work description:
Work location:

This form is valid for the specified time:

From: Hrs: Date:
To: Hrs: Date:
Tank No / name of enclosed space/tank :

Precautions have been explained to all personnel involved
Usage of Enclosed Space :
Name of subcontractor in case used:
Name and signature of person entering enclosed space:
Person entering:
(Signature)
All the checks have been performed before entering enclosed space/tank
The space has been segregated thoroughly
Space cleaned
Space ventilated thoroughly
The atmosphere has been tested and found to be safe
Oxygen: (21%)
CO: (30 ppm)
A person standing by at entrance (Name-surname)
Other stand by person(s):
All lifesaving and evacuation equipment are ready
(VHF) / All communication equipment are ready (VHF)
Access way is open and lighting is sufficient
Work plan made
Rescue and resuscitation equipment are available
Emergency procedure agreed
All relevant personnel acknowledged
The below checklist will be filled by the work leader
All the above part completely filled
The space will be evacuated urgently in case of ventilation faults
Agreed on communication (Write down VHF channel)
Communication period agreed (Must be stated)
Emergency procedure agreed
According to the checks and preparations made the space found to be safe to enter
THIS PERMIT IS ONLY VALID FOR THE SPECIFIED TIME. IT MUST BE RENEWED
IN CASE OF VENTILATION FAILURE OR ANY OTHER CONDITION CHANGE.
Person entering:
Stnd by person
Person in charge
Remarks:

Form C 08
MARSIG mbH
Change Over Report - SO
Back Voyage No.: 01/14
Charterer
Particular conditions in ports of call, circular trade, ports with
peculiarities
Basic port (port authorities, agents, ship chandler, customs..)
Other messages, reports, dispatches
Inventory and validity of ship's safety eq. / certificates / last class
survey
System ISM, ISPS
Port documents & formalities
Arrival / Departure information
Safety equipment inventory
Safety equipment checklist
Charts / publications and their correction status
Deviation tables
Navigational equipment
Voyage Planning
Communication Folders (Tlx…)
Safety euipment - inspection & maintenance status
Familiarization with state of controls of safety equipment
Familiarization with location & use of safety equipment
Familiarization with use of emergency fire pump & generator.
Familiarization with state of drills and lectures to the crew
Familiarization with manoeuvring station related to mooring /
unmooring of the
Familiarization vessel
with cargo duty under observation of Chief
Officer’s advises
Familiarization with state of order and supply lists (nautical
publications)
Radio Logbook
GMDSS Logbook
Muster List
Medicine chest / hospital eq - inventory
Handling of medical equipment
Medical logbook / Medical guide / MfAG
Signature, leaving SO Signature, signing on SO

Form C 09
MARSIG mbH
Change Over Report - CO
Back Voyage No.: 01/14
Charterer
Particular conditions in ports of call, circular trade, ports with
peculiarities
Basic port (port authorities, agents, ship chandler, customs..)
Information to reliable / efficient fuel bunkering
Information to reliable / efficient fresh water bunkering
Cargo, Dangerous Goods, Reefer, Special Containers, Ballast
and Stability information
Manoeuvering characteristics of vessel
System ISM, ISPS
Crew qualification, abilities, training status
Outstanding Deliveries / Sparepart requirements
Technical failures, summery of Damage Reports
Outstanding repairs
Plan of damages in vessel's hull
Vessel inspected
Watch Arrangement / Rest Time acc STCW and Flag
Requirements (see M12 'Monthly statement')
Clear and only ONE documentation of working / rest hours on
company's form No M06
Vessel inspection
Desciption Condition status (1-3)
Ship / Stability / Hull information
Tank conditions
Cell guide conditions
Cargo hold conditions
Stack weight / limits
Container stowage limitations
CSM
Stability booklet, emergency stability
Tank tables
Lashing equipment inventory
Ballast Water System / condition of sensors
Cargo Computer, cargo program - calculation
Charters cargo equipment (spreader / hoacks / slings)
Radio Station
Radio facsimile receiver operable?
VHF 2 pcs operable?
INMARSAT C - set operable?
GMDSS manuals for installed eq. on board
NAVTEX Receiver operable?
Two way walkie talkie min 3 pcs operable?
Deck
Hatch rubbers
Pontons
Cargo Crane 1 / 2
Runner - greasing
Runner - last renew
Crane gear
Crane cabin

Form C 09
MARSIG mbH
Change Over Report - CO
Power supply
Provision Crane(s)
Crane gear
Power supply
Lashing store(s)
Bosun store
Paint store
Anchor windlass condition?
Are there any problems dropping the anchor?
Manual stowage of anchor chain required?
Number and condition of the mooring ropes
Are the pilot ladders in good condition?
How is the condition of vessel’s gangway’s
Painting of vessel?
Superstructure
Stores
Other stores, lavatories, rooms
Bord organisation
Drills, meetings - weaknesses
Handing over of:
Key Box, Key procedure
Cargo documents
Digital camera + equipment (charger, ...)
One duty helmet, lifejacket
ISM Manuals
Security Plan
CSM
Paint inventory
Garbage Management Plan
Garbage Look Book
Cargo Gear Book
Ballast Water Management Plan
Signature, leaving CO Signature, signing on CO

Form I 01
MARSIG mbH
Declaration of Security
Back Form for a Declaration of Security between a ship and a port facility *
DECLARATION OF SECURITY
Name of ship:
Port of registry:
IMO Number:
Name of port facility:
This Declaration of Security is valid from ……………...……….. until ………………….……..

for the following activities:
………………………………..…………………...………………….
(list the activities with relevant details)
under the following security levels
Security level(s) for the ship:

Security level(s) for the port facility:
The port facility and the ship agree to the following security measures and responsibilities to ensure
compliance with the requirements of part A of the International Code for the Security of Ships and of
Port Facilities.
The affixing of the initials of the SSO or the PFSO under

these columns indicates that the activity will be done, in
accordance with relevant approved plan, by
Activity The port facility: The ship:
Ensuring the performance of all security duties
Monitoring restricted areas to ensure that only

authorized personnel have access
Controlling access to the port facility
Controlling access to the ship
Monitoring of the port facility, including the

berthing areas and areas surrounding the ship
Monitoring of the ship, includinf berthing areas and
areas surrounding the ship
Handling of the cargo
Delivery of ship's stores
Handling of unaccompanied baggage
Controlling of the embarkation of persons and their

effects
Ensuring that security communication is readily
available between the ship and the port facility
Revision: 01.01.2008 approved by CSO page 37 of 81

Form I 01
MARSIG mbH
Declaration of Security
The signatories to this agreement certify that security measures and arrangements for both the port
facility and the ship during specified activities meet the provisions of chapter XI-2 and part A of the
Code that will be implemented in accordance with the provisions already stipulated in their approved
plan or the specific arrangements agreed to and set out in the attached annex.
Dated at …………………………..…………. on the ……………………………………………..
Signed for and on behalf of
the port facility: the ship:

(Signature of port facility officer) (Signature of master or ship security officer)
Name and title of person who signed
Name: Name:
Title: Title:
Contact details
(to be completed as appropriate)
(indicate the telephone numbers or the radio channels or frequencies to be uses)
for the port facility: for the ship:
Port facility Master
Port facility security officer Ship security officer
Company
Company security officer
* This form of Declaration of Security id for use between a ship and a port facility. If the Declaration
of Security is to cover two or more ships, this model should be appropriately modified.
Revision: 01.01.2008 approved by CSO page 38 of 81

FORM I02
MARSIG mbH
ISPS Familiarisation

Back
Master: Ihwan Asrul Date: 4/11/2018
Vessel’s specific shipboard Introduction and Explanation of Ship Security Procedures
Following new crew members were briefed and familiarized and introduced to the Ship’s Security in
accordance with the ISPS Code understanding the necessity and the measures of this ship. Special
security duties (part A and B of this code), changing of Security Level, gangway watch, search,
protection of Restricted Areas and others were explained, accepted and can be performed.
No. Crew member/ Name Rank on board Signature
Remarks
Signature SSO:

Form I 03
MARSIG mbH
Last 10 Ports of Call
MV: FSO Surya Putra Jaya Year: January

Back
Master: 01/14 Month: Oyong Terminal
No Port Name Port Facility Port Security Level Arrival Departure
10
Remarks
Signature SSO:

Form I 03
MARSIG mbH
Last 10 Ports of Call

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Inventory of Forms MOTNHLY QUARTERLY CHECKLISTS

IMO No. 9018426 M 03 Greasing / Hull Q 03 Security Equipment C 03 Familiarisation

Gross Tonnage 25808 M 04 Paint Inventory Q 04 Tank Summary C 04 Master Change

Call Sign PNRP M 05 Training Plan FAL FORMS C 05 Welding Work

Voyage No 01/14 Form M 13 Watch Plan F 02 Passenger List C 07 Enclosed Spaces

Year 2014 M 14 Stability Report F 03 Ship Stores C 08 Change over SO

Month January M 15 Monthly Statement F 04 Crew Effects C 09 Change over CO

Port of arrival Oyong Terminal M 16 Taining Report F 05 General Declaration

Date of arrival 01/01/14 F 08 Vaccination List Crew Fam 04Crew Fam 05

Port of Departure Oyong Terminal M 11 M 12 I 01 Declaration of SecurityI 01 ISPS Familiarization

Next Destination Oyong Terminal

Date of Departure 31/12/14

Master Ihwan Asrul Month: January

Monthly M 01 Safety Equipment 06 SO monthly

Quarterly Q 01 Safety Equipment 06 Master quarterly

FAL F 01 Crew List 06 Master if changed x x

Checklst C 01 Arrival Check 06 WO

ISPS I 01 Declaration of Security 06 SSO all x x

Revision: 0 Approved by DP Page 2 of 81

Revision: 0 Approved by DP Page 3 of 81

Speed and Distance indicators in working condition

Two-way VHF radios and valid batteries 01.02.08 x

Magnetic Compasses liquid level satisfactory 01.02.08 x

Revision: 01.01.2008 Approved by DP Page 4 of 81

Test of general alarm,-Check that all bells, horns,

Check for easy opening of doores, windows. Check

Check fire pumps and supply water with sufficient

Revision: 01.01.2008 Approved by DP Page 5 of 81

MV: FSO Surya Putra Jaya Year: 2014

Plans and Instructions 01.02.08 x

Revision: 01.01.2008 Approved by DP Page 6 of 81

Oyong Terminal FSO Surya Putra Jaya

Revision: 01.01.2008 Approved by DP Page 7 of 81

MV: FSO Surya Putra Jaya Year: 2014

Fire hose couplings 01.02.08

Fire hydrants & nozzles 01.02.08

Firemains drain valves 01.02.08

Anchor quick-realising device 01.02.08

Anchor covers, bolts+nuts 01.02.08

ER ventilation fire dampers 01.02.08

Lashing Material monthly

Hull inspection quarterly

Ship side shell plates 01.02.08

Condition of cargo holds 01.02.08

Watertight doors 01.02.08

Manhole covers 01.02.08

Bulkheads, frames 01.02.08

Tank top, brackets 01.02.08

Catwalks, handrails, bulwarks 01.02.08

Crane No. 1 quarterly

Crane No. 2 quarterly

Prov. Crane No. 1 quarterly

Revision: 01.01.2008 Approved by DP Page 8 of 81

Prov. Crane No. 2 quarterly

Accomodation Ladders quarterly

Vent-Flaps Fwd. 01.02.08

Vent-Flaps Aft 01.02.08

Revision: 01.01.2008 Approved by DP Page 9 of 81

MV: FSO Surya Putra Jaya Year: 2014

Revision: 01.01.2008 Approved by DP Page 10 of 81

MV: FSO Surya Putra Jaya Year: 2014

Fire Drill (including First Aid) x x x x x x x x x x x x

Man over Board, SAR x x x x

Main Engine Failure x