| APPENDIX 1
|
| GENERAL PARTICULARS
|
| Ship's 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:
|
| * Delete as
appropriate
|
|