Ship's name:
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IMO Number:
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Administration Identification
Number:
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Port of registry:
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Gross tonnage:
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Deadweight:
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Date of build:
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Classification society:
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Name of Company performing the
thickness measurement:
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Thickness measurement company
certified by:
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Certificate No.:
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Certificate valid from:
.....................................................
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to
.......................................................
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Place of measurement:
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First date of measurement:
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Last date of measurement:
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Renewal
survey/intermediate surveyfootnote due:
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Details of measurement
equipment:
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Qualification of
operator:
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Report Number:
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Consisting of ……......
Forms
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Name of operator:
...............................................
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Name of surveyor:
.........................................
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Signature of operator:
.........................................
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Signature of surveyor:
...................................
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Company official stamp:
.....................................
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Administration official
stamp: ......................
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