International Convention on Load Lines, 1966
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Record of Conditions of Assignment
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Name of
ship.........................................................................................................................
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Port of
registry......................................................................................................................
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Nationality..............................................................................................................................
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Distinctive number or
letters.................................................................................................
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Shipbuilders..........................................................................................................................
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Yard
number.........................................................................................................................
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Date of
construction/conversion...........................................................................................
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Freeboard assigned as a ship of
Type.................................................................................
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Classification........................................................................................................................
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Date and place of initial
survey.............................................................................................
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A plan of suitable size may be
attached to this Report in preference to sketches on this page.
Disposition and
dimensions of superstructures, trunks, deckhouses, machinery casings; extent of
bulwarks, guard rails and wood sheathing on exposed deck, to be inserted in the diagrams
and tables following; together with positions of hatchways, gangways and other means for
the protection of the crew; cargo ports, bow and stern doors, sidescuttles, scuppers,
ventilators, air pipes, companionways, and other items that would affect the
seaworthiness of the ship.
![](GUID-2D2D582B-99FE-45D2-859F-8C8679A96B79-low.png)
Doorways in superstructures, exposed machinery casings and deckhouses protecting
openings if freeboard and superstructure decks (Regulations 12, 17 and 18)
Location
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Ref. No.
on sketch or plan
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Number and
size of openings
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Height of
sills
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Closing appliances
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Type and
material
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Number of
clips
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In forecastle
bulkhead
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In bridge forward
bulkhead
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In bridge after
bulkhead
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In raised
quarter-deck bulkhead
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In poop
bulkhead
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In exposed machinery
casings on freeboard or raised quarter-decks
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In
exposed machinery casings on superstructure decks
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In
machinery casings within superstructures or deckhouses on freeboard
deck
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In
deckhouses in Position 1 enclosing openings leading below freeboard
deck
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In
deckhouses in Position 2 enclosing openings leading within enclosed
superstructures or below freeboard deck
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In
exposed pump-room casings
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Hatchways at positions 1 and 2 closed by portable covers and secured weathertight by
tarpaulins and battening devices (Regulation 15)
Position and Reference No. on sketch or plan
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Dimensions of clear opening at top of coaming
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Height of
coamings above deck
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PORTABLE BEAMS
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Number
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Spacing
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b
1 × t
f
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D × t
w
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b
2 × t
f
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Bearing surface
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Means of securing each beam
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PORTABLE COVERS
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Material
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Thickness
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Direction fitted
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Bearing surgace
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Spacing
of cleats
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TARPAULINS
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No. of layers
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Material
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Means of securing each section of covers:
Are wood covers fitted with galvanized end bands?
Hatchways at positions 1 and 2 closed by weathertight covers of steel (or other
equivalent material) fitted with gaskets and clamping devices (Regulation 16)
Position and Reference No. on sketch or plan
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Dimensions of clear opening at top of
coaming
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Height of coamings above deck
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Type of cover or patent name
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Material
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Machinery space openings and miscellaneous openings in freeboard and superstructure
decks (Regulations 17 and 18)
Positions and Reference No. on sketch or plan
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Dimensions
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Height of
coaming
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COVER
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Material
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How attached
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Number
and spacing of toggles
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Position
and Reference No. on sketch or plan
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Dimensions
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Height
of coaming
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COVER
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Number
and spacing of toggles
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Ventilators on freeboard and superstructure decks (positions 1 and 2) (Regulation
19)
Deck on
which fitted
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Number
fitted
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Coaming
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Type (State patent name if any)
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Closing
appliances
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Dimensions
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height
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Air pipes on freeboard and superstructure decks (Regulation 20)
Deck on
which fitted
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Number
fitted
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Coaming
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height
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Type (State patent name if any)
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Dimensions
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Closing
appliances
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Cargo port and other similar openings (Regulation 21)
Position of
port
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Dimensions of
opening
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Distance of lower edge
from freeboard deck
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Securing
devices
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Remarks
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Scuppers, inlets and discharges (Regulation 22)
State if
scupper or discharge
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Number
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Pipe
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From
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Vertical distance above top of keel
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Number,
type and material of discharge valves
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Position
of controls
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Diameter
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Thickness
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Material
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Discharge
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Uppermost
value
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Outlet in hull
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Inboard
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S -
Scupper
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MS -
Mild steel
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SD -
Screw-down
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D - Discharge
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CS -
Cast steel
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ANR - Automatic
non-return
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GM - Gun
metal
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SD ANR - Screw-down
automatic non-return
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Any other approved material to
be designated
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Sidescuttles (Regulation 23)
Position
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Number
fitted
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Clear
glass size
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Fixed or
opening
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Material
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Type of
glass and thickness
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Standards
used and Type No.
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Frame
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Deadlight
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Indicate the vertical distance between the freeboard deck and the lower sill of the
sidescuttle positioned at the greatest vertical distance below the freeboard deck.
Freeing ports (Regulation 24)
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Length of
bulwark
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Height of
bulwark
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Number and size of
freeing ports each side
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Total area each
side
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Required area each
side
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Freeboard deck after well
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Forward well
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Superstructure deck
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State fore and aft position of each freeing port in
relation to superstructure end bulkheads
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After well
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Forward well
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Particulars of shutters, bars or rails fitted
to freeing ports
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height of lower edge of freeing port above
deck
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Protection of the crew (Regulations 25 and 26)
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State particulars of bulwarks or guard
rails on freeboard and superstructure decks:
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State details of lifelines, walkways,
gangways or underdeck passageways where required to be fitted:
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Timber deck cargo fittings (Regulation 44)
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State
particulars of uprights, sockets, lashings, guard rails and
lifelines:
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The
conditions of assignment shown on this form are a record of the arrangements
and fittings provided on the ship and are in accordance with the
requirements of the relevant regulations of the International Convention on
Load Lines, 1966.
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(Surveyor's signature)
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(Date)
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