| Ships Name
|
| IMO number:
|
| Class/Administration identity Number:
|
| Port of Registry:
|
| Gross Tonnage:
|
| Deadweight:
|
| Date of build:
|
| Classification society:
|
|
|
| Name of company performing thickness
measurement:
|
| Thickness measurement company certified by:
|
| Certificate number:
|
| Certificate valid
from:...................................................to............................................................
|
| Place of measurement:
|
| First date of measurement:
|
| Last date of measurement:
|
| renewal survey/intermediate survey due*:
|
| Details of measurement equipment:
|
| Qualification of Operator:
|
| Report
Number:
|
consisting of
pages
|
| Name of
operator:............................................
|
Name of
surveyor............................................
|
| Signature
of operator:......................................
|
Signature of
surveyor......................................
|
| Company
Official stamp:..................................
|
Administration:
...............................................
|
|
|
Official stamp:
|
|
|
|