Standard Formulir Aktivitas Kapal Di Pelabuhan

7/25/2019 Standard Formulir Aktivitas Kapal Di Pelabuhan

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2/28

PT PERTAMINA (PERSERO)SHIPPINGMARKETING & TRADING DIRECTORATESHIPPING OPERATION DIVISION, HEAD OFFICE 19

THFloor, Jln. Merdeka Timur 1A Jakarta 10110

Phone : (62-21) 3816367, 3816314, 3816339, 3816353, 3816217. Fax : 3455430, 3816348, 3507121E-mail: [email protected]

COMPARTMENT LOGSHEETAFTER/BEFORE/LOADING/DISCHARGING

VESSELS NAME : DRAFT (Mtr) F M A

PORT / DATE : BEFORE LOAD / DISCH :

VOYAGE : AFTER LOAD / DISCH :

LOADING MASTER PT. PERTAMINA (PERSERO) CHIEF OFFICERShipping Representative/Agent

CARGOTANKS

NO

TANK OBSERVATION SAMPLES OBSDENSITY@ 15C

(TABLE 53)

VOL CORFACTOR

(TABLE 54)

NET KL@ 15C

VOLUMECONV

FACTOR(TABLE 52)

BARRELS@60F

WEIGHTCONV

FACTOR(TABLE 57)

LONGTONS

METRTONGRADE

CORRULL

GROSSVOL (KL)

FREE WATER NETVOL(KL)

DENSTEMP(oC )DIP

VOL(KL)

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17PORT

1

2

3

4

5

6

7

8

CENTER

1

2

3

4

5

6

7

8

STBD

1

2

3

4

5

6

7

8

TOTAL


3/28

PT PERTAMINA (PERSERO)SHIPPING MARKETING & TRADING DIRECTORATESHIPPING OPERATION DIVISION, HEAD OFFICE 19



DELIVERY CERTIFICATE

It was also agreed at that time that the vessel had onboard bunker and freshwateras follows :

Marine Fuel Oil : Metric Ton.

Marine Diesel Oil : Metric Ton.

Autogas (HSD) : Metric Ton.

Fresh Water : Ton.

Port

:Date :

PT PERTAMINA (PERSERO) Master MT / SS / TB

Representative

(For and on behalf of Charterer) (For and on behalf of Owner)

This is to certify that MT / SS / TB : Call Sign

Flag : Gross Tons : was duly delivered

by the Master (for and on behalf of Owner), to and accepted byPT PERTAMINA (PERSERO)

(for and on behalf of Charterer), at

hours local time, on


4/28

Name of Ship Disch. Port

Voy No. F : . . . . . . . .

Date Loading Port M : . . . . . . . .

Berth/Jetty A : . . . . . . . .

:

:

:

:

Load/Disch. Rate / Pressure at Manifold as Agreement : . . . . . . . . . . . . .KL/hrs - . . . . . . . . . . .kg/cm2

Remark :

Note :

Line : Pipa (muat / bongkar) SFBD : Ship's Figure Beofore Discharge F : Forward (depan)

LA : Loading Arm (pipa muat) Voy No.: Voyage No. (No. Pelayaran) M : Mid (tengah)

COP : Cargo Oil Pump (pompa utama) KL Obs : Kilo Liter Observasi (pengamatan) A : After (belakang)

Line : Diameter pipa dalam inchi Shore : Darat Hrs : Jam

Grade : Jenis Muatan

Berth/Jetty : Nama tempat sandar (dermaga/SBM)

- Kegiatan bongkar harus direcord dalam pumping log dan ditandatangani pihak kapal dan pihak darat.

-

Line= inchiGrade

1.

Estimated Completed Load/Disch. time

(including stripping):

3.

. . . . . . . . . . . . . . . . . . .hrs

RECEIVING AVAILABILITY AND CAPACITY

Shore Ship's

kg/cm2kg/cm2

M

PT. PERTAMINA (PERSERO)

DIREKTORAT PEMASARAN DAN NIAGA - PERKAPALAN

LOADING/DISCHARGING AGREEMENT

COP

2.

Quantity Load/Dis

in KL ObsLine = inchi

. . . . . . . . . . . . . . . . . . . . . . . . .

: . . . . . . . . . . . . . . . . . . . . . . . . . .

: . . . . . . . . . . . . . . . . . . . . . . . . . .

: . . . . . . . . . . . . . . . . . . . . . . . . . .

: . . . . . . . . . . . . . . . . . . . . . . . . . .

Draft

M

. . . . . . . . . . . . . . . . . . .

In the event the discharging rate/pressure at manifold of the vessel is below the agreement mention above

then the vessel will be claim for slow pumping, if the slow pumping is caused by the vessel fault.

M

Loading Master

Pressure

C O P use

Line(LA) use &

Load/Disch. Rate

Penurunan tekanan / rate atas permintaan darat/kapal harus dibuat secara tertulis dan ditandatangani pihak kapadarat

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

: . . . . . . . . . . . . . . . . . . . . . .

: . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

KL/hrs KL/hrs

Total Quantity Load/ Discharge =

Master


5/28




DRY CERTIFICATE(After Discharging)

To:

I, the Loading Master, have inspected all ships tanksat hours local time, on 20

and found dry & empty.

All cargo on board has been delivered in good order and condition

Remark:Quantity of ROB :

or OBQ

Yours truly,

Loading Master

To Loading Master,

We confirmed acceptance of your written dry certificate at

hours local time, on

Yours truly,

Master

PORT:

DATE: 20


6/28




DRY CERTIFICATE(Before Loading)

To:

I, the Master of , have inspected all ships tanks

at hours local time, on 20

and found dry & clear.

And ready to commence loading of the cargo

Remark:Quantity of ROB :

or OBQ :

Yours truly,

Master

To Master of MT,

We confirmed acceptance of your written dry certificate at

hours local time On

Yours truly,

Loading Master

PORT:

DATE: 20


7/28




INSPECTION RECORD

SHIPS COMP.

BOTTOM WALL VALVE HEATING COILS HEATING COILS

EmptyFree

WaterClean D/S/WP Clean D/S/WP O/C Sealed

SealedNumber

D/S Leak Empty Content

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14)

PORT 1

2

34

5

6

7

8

CENTER 1

2

3

4

5

6

7

8

STBD 1

2

3

4

5

6

7

8

Cofferdam

Slop Tank

Fore Peak Tank

After Peak Tank

Notes: Oil Inspector for Cleanliness : P&T Agent Oil Inspector/ Loading Master Mualim I / Chief Officer

Loading Master: for Cargo

Discharging Master

Discharging Master


8/28




SURAT PERBEDAAN ANGKA MUATAN

LETTER OF DISCREPANCY

Tanggal:

Date

Voyage :

Pelabuhan:

Port

Kepada:

To

Dari Nakhoda:

From Master

Setelah pengecekan kembali dengan teliti figuresmuatan yang dimuat serta disesuaikan dengan draftdan deadweight dari kapal kami, maka terdapatperbedaan lebih dari setengah () persen antara B/Lfigures dengan ships figures dengan perinciansebagai berikut :

After having been rechecked the figures of thecargo loaded carefully and compared it with thedraft and deadweight of our vessel, a differenceof more than half () percent between B/L andthe ships figures has been found as follows :

Jenis Angka Kapal No. dan angka B/L Selisih

Grade Ship Figures No. and B/L figures Difference

Bbls Bbls %

Bbls Bbls %

Bbls Bbls %

Berdasarkan figures tersebut diatas dengan ini kamimenyatakan bahwa B/L telah kami tandatanganidibawah protes dengan ketentuan bahwa kapaltidak dapat dipertanggung jawabkan atas figurespembongkaran pada pelabuhan bongkar.

Catatan :

Tanker Ullage Report pertama dan kedua diukur

dan dihitung bersama-sama Loading Master sertaAgen dan telah diserahkan ke perwakilan/AgenPT. PERTAMINA (PERSERO).

Base on above mentioned figures, we here bydeclare that the B/L has been signed underprotest, notably that the ship could not be holdresponsible for the outturn figures at thedischarging port.

Remarks :

The first and the second Tanker Ullage Report

already measure and calculated together withLoading Master and Agent and send toPT. PERTAMINA (PERSERO) Representative.

Hormat kami Diketahui

Yours faithfully Known by

NakhodaPT PERTAMINA (PERSERO)

Representative

Master


9/28




LETTER OF PROTEST

Slow Pumping

DATE :

PORT :

BERTH :

To :

As recorded, that my vessel is capable to loading / discharging cargo at

TONS/BBLS/M per hour with

line inches connection. However, shore can only supply /receive of

TONS/BBLS/M3per hour

line. Equivalent to hours actual loading /discharging time.

In view of the foregoing, I Master of MT protest the delay of

loading / discharging and on behalf of my Owners and Consignee / Charterer reserves

their right to claim you for all time losses and expenses incured, if any, and that such

claims to forthcome at an appropriate time and place my principal deemed it.

Loading Master Master / Duty Officer

Port of :

Date :


10/28




LOG ABSTRACT(The voyage should cover the period End of Sea Voyage as per Log at first Loading Port until return same position Next Loading Port, after discharging all cargo)

VESSEL NAME : VOYAGE NO :

PORT TIME : (Loading / Discharging)

PortEnd of Sea Voyage Begin Of Sea Voyage Port Time

(Hours)

Cargo Load / Disch. (Long Ton)Activity Date Time Description Hours

Fuel & FW Counsumption (MT)

Date Time Date Time B / L SFAL/SFBD Grade MFO MDO HSD FW

St. by. Eng. (EOSV) Steaming in/out

FWE Idle

St. by. Eng. Load/ Disch

FWE Ballast/ Deballast

Remark : Comm. Load/Disc. Cargo HeatingComplt. Load/Disc. IGS

St. by. Eng. Total

FWE

St. by. Eng. ROB ATA

Full Away (BOSV) ROB ATD

REPLENISHMENT

SEA PASSAGE : (Laden / Ballast)

From

(BOSV)

To

(EOSV)

Distance

(Miles)

Steaming

Time (Hours)

Av. Speed

(Knots)

Fuel & FW Consumption (MT) Description Hours

MFO MDO HSD FW Heat

Port: Port: Tk. Clean

Date: Time: Date: Time: IGS

PORT TIME : (Loading / Discharging)

PortEnd of Sea Voyage Begin Of Sea Voyage Port Time

(Hours)

Cargo Load / Disch. (Long Ton)Activity Date Time Description Hours

Fuel & FW Counsumption (MT)

Date Time Date Time B / L SFAL/SFBD Grade MFO MDO HSD FW

St. by. Eng. (EOSV) Steaming in/out

FWE Idle

St. by. Eng. Load/ Disch

FWE Ballast/ Deballast

Remark : Comm. Load/Disc. Cargo Heating

Complt. Load/Disc. IGS

St. by. Eng. Total

FWE

St. by. Eng. ROB ATA

Full Away (BOSV) ROB ATDREPLENISHMENT

SEA PASSAGE : (Laden / Ballast)

From(BOSV)

To(EOSV)

Distance(Miles)

SteamingTime (Hours)

Av. Speed(Knots)

Fuel & FW Consumption (MT) Description Hours

MFO MDO HSD FW Heat

Port: Port: Tk. Clean

Date: Time: Date: Time: IGS

State exast periods of delay caused by accident engine troublecrewheavy weather and the like :

Deviation to storing and / or repair port :

Master :

Distance to go at time of deviation to next loading / discharging port : Miles.

lace / Point of Deviation Date / Hour

Returned to point of deviation or corresponding position Date / Hour

Actual periode of deviation : Days Hour Chief Engineer :

Bunker and F.W. consumed during the deviation periode FO : DO : HSD : FW :


11/28




RE : DEPARTURE MASTER CABLE

ROC. 1863 / OT II DATED 18 / 08 / 1999 AS TO GET A COMPLETE DEPARTURE

MESSAGE. YOU ARE REQUESTED TO ADVISE ALL DETAILS BELOW AT THE FIRST

PRIORITY FOR EACH ACTIVITY:

AA.

BB.

CC.

DD.

EE.

FF.

GG.

DD.

EE.

FF.

GG.

HH.

II.

JJ.

KK.

LL.

MM.

NN.

OO.

PP.

QQ.

RR.

SS.

TT.

UU.

VV.

WW.

XX.

YY.

THANKS FOR YOUR ATTENTION COOPERATION ACK REGARDS.


12/28




MASTERS REQUISITION

Port :

Date :

Dear Sir :Please supply my vessel the as / my : With,

MARINE FUEL OIL KL / MT

Maximum viscosity redwood 1 @ 100 o F Seconds

Rate per hour for delivery

MARINE DIESEL FUEL KL / MT


GAS OIL KL / MT


DRINGKING WATER Tons

BOILER WATER Tons

And charge same to my Principals namely :

I require the grades to be supplied in the following order :And * will / * will not appoint a representative to withness and check either the opening and closing meterreadings/ calculations or if meters no available, the opening and closing tank dips/calculations onlybehalf.The ship / * there will give the final stop pumping signal.

Your very truly

Master MT :

( )


13/28




NOTICE OF READINESS

Voy. No.

PORT :

DATE :

TIME TENDERED :

To:

Dear Sir,

I hereby tender you the MT

at the date time shown above as being ready in all respect to commence the

loading/ discharging of her cargo

consisting of:

Description of cargo Approximate amount/Bill of Lading quantity

Laytime will commence as specified in the charter party covering this voyage

ACCEPTED Very truly yours

Date : Hour:

By :as Agent Master


14/28




NOTICE OF SEALINGNo :

After completing : cargo

Loaded in tank :

Of the MV / MT :

On the :

The following valves and tanklide were sealed by Loading

Number and name valves/tanklide sealed :: pcs

: pcs

: pcs

: pcs

: pcs

: pcs

: pcs

: pcs: pcs

: pcs

: pcs

Total : pcs

20

Scaling Acknowledge by : Signature

Chief Engineer Loading Master

Cc : ConsigneeChief OfficerPelsusInst. Tank


15/28




OFF HIRE CERTIFICATE

This is to certify that MT / SS / TB :

Call Sign: Flag :

DWT : was dulyoff hire by PT PERTAMINA (PERSERO)

(for and on behalf of Charterer), to and accepted by Master (for and on behalf of

owner), at hours local time, on

It was also agreed at that time that the vessel had onboard bunker and freshwater

as follows :

Marine Fuel Oil (180cst/380cst)* : Metric Ton.



Marine Gas Oil (MGO) : Metric Ton.

Fresh Water : Ton.

*)coret yang tidak perlu

Port :

Date :

Master MT / SS / TB PT PERTAMINA (PERSERO)Representative

(For and on behalf of Owner) (For and on behalf of Charterer)


16/28




LAPORAN PEMERIKSAAN PENCEGAHAN TUMPAHAN MINYAK DI PERAIRAN

1. Kapal Terminal

2. Pemilik Kapal

3. Dioperasikan oleh

4. Agen Nama Alamat

5. Nama Nakhoda

6. Tiba di Tgl jam

Di dermaga Tgl jam

7. Berlabuh jangkar dari jam Tgl sampai jam Tgl

8. Jenis muatan

9. Apakah Oil Boom dipasang

10. Apakah kerangan-kerangan pipa pembuangan air ballast kotor / air got ke laut tertutup rapat sebelum

penyegelan

11. Apakah semua penutup lubang untuk mengukur minyak di tangki muatan (ullage cover screens) ada pada

tempatnya sebelum pemompaan dimulai

12. Jumlah segel yang digunakan

13. Jumlah dispersant yang ada di kapal

Jenis Merk Pabrik

14. Tanda tangan Perwira dan Pemeriksa Darat yang melaksanakan penyegelan :

( ) ( )

Perwira Kapal Pemeriksa Darat

15. Apakah saluran pembuangan air dekkapal sudah disumbat sebelumpompa dihidupkan

Apakah talang penadah tumpahanminyak berada dibawah manifoldkapal

Apakah talang penadah tumpahanminyak untuk kapal tersedia di darat.

16. Slang terakhir telah terpasang jam tgl 20

Pembongkaran/pemuatan dimulai jam tgl 20

17. Selesai pembongkaran/pemuatan jam tgl 20

Slang terakhir dilepas jam tgl 20

Apakah ujung slang terakhir telah tertutup rapat waktu dimulainya pemompaan ballast diatas kapal

sebelum diturunkan ke darat jam tgl 20

Waktu segel dibuka untuk pengisian air ballast apakah segel-segel masih utuh sebelum dibuka

jam tgl 20

18. Tanda tangan Perwira Kapal dan Pemeriksa Darat waktu membuka segel :

( ) ( )

Perwira Kapal Pemeriksa Darat

19. Apakah saluran pembuangan airdek kapal sudah disumbatsebelum pompa dihidupkan

Apakah talang penadah tumpahanminyak berada dibawah manifold kapal

Apakah talang penadah tumpahanminyak untuk kapal tersedia di darat.

20. Bilamana ada minyak terlihat diatas air disekitar kapalberikan laporan terperinci dibawah ini :


17/28




ON HIRE CERTIFICATE

This is to certify that MT / SS/ TB :

Call Sign: Flag :

DWT : was dulyon hire by the Master

(for and on behalf of Owner) to and accepted by PT PERTAMINA (PERSERO)

(for and on behalf of Charterer),

at hours local time, on

It was also agreed at that time that the vessel had onboard bunker and fresh water

as follows :





Fresh Water : Ton.

*)coret yang tidak perlu

PT PERTAMINA (PERSERO) Master MT / SS / TBRepresentative


Port :Date :


18/28




ON HIRE CERTIFICATE

This is to certify that MT / TT/ TB :

Call Sign: Flag :

DWT : was dulyon hire by the Master

(for and on behalf of Owner) to and accepted by PT PERTAMINA (PERSERO)

(for and on behalf of Charterer),

at hours local time, on

It was also agreed at that time that the vessel had onboard bunker and fresh water

as follows :

Marine Fuel Oil : Metric Ton.


Auto as HSD : Metric Ton.

Fresh Water : Ton.

PT PERTAMINA (PERSERO) Master MT / TT / TBRepresentative


Port :

Date :


19/28

MT PRESS ALLOW BY SHORE ON HOSE : kg/m2

PORT OF DATE AVERAGE PRESS MAINTAINED SHIP RAIL : kg/m2

NO OF PUMP NORMAL SERV. RPM NO OF HOSE : SIZE : inches

SHORE LINES NO : SIZE : inches

RPM

PRESS

AT RAIL

(kg/cm2)

PUMPING

RATE

(m3/h)

RPM

PRESS

AT RAIL

(kg/cm2)

PUMPING

RATE

(m3/h)

RPM

PRESS

AT RAIL

(kg/cm2)

PUMPING

RATE

(m3/h)

RPM

PRESS

AT RAIL

(kg/cm2)

PUMPING

RATE

(m3/h)

NOSG/

DENSITY

1 DATE HOUR MINUTE DATE HOUR MINUTE

2

3

4

5

6

7

PRESSURE RECORDED SHIP' RAIL / UPPER PUMP ROOM / LOWER PUMP ROOM :

IF ANY PUMP WAS NOT IN OPERATION ADVISE REASON :

IF DISCHARGEING INTERUPTED ADVISE REASON :

IF NORMAL RPM WERE NOT MAINTAINED ADVISE REASON :IF ANY DELAY INCURRED DUE TO SHORE ORDER ATTACH WRITTEN INSTRUCTION :

PT PERTAMINA (PERSERO) CHIEF OFFICER MASTER

DATE HOURS

MAIN PUMP NO.3MAIN PUMP NO.1 MAIN PUMP NO.2

REMARKS

MAIN PUMP NO.4

::

PT PERTAMINA (PERSERO)

SHIPPING OPERATION DIVISION, PT PERTAMINA (PERSERO) HEAD OFFICE 11TH

Floor, Jln. Merdeka Timur 1A Jakarta 10110

Phone : (62-21) 3816367, 3816314, 3816369, 3816353, 3816217. Fax : 3455430, 3816348, 3507121

E-mail: [email protected]

CARGO GRADE AND

QUANTITY

TEMP OBSERVED

(oC)

PUMPING / DISCHARGE LOG

SHIPPING - MARKETING & TRADING DIRECTORATE

:

::

COMMENCED DISCHARGE COMPLETED DISCHARGE DISCH.

TIME

STOP DISCHARGE TOTAL

STOPREASON

FROM TO


20/28




REDELIVERY CERTIFICATE

This is to certify that MT / SS / TB : Call Sign :

Flag : DWT : was duly redel ivered by

PT PERTAMINA PERSERO

(for and on behalf of Charterer), to and accepted by Master (for and on behalfOwner), at hours local time, on

It was also agreed at that time that the vessel had onboard bunker and freshwateras follows :





Fresh Water : Ton.*) coret yang tidak perlu

Port :

Date :

Master MT / SS / TB PT PERTAMINA (PERSERO)Representative

(For and on behalf of Owner) (For and on behalf of Charterer)


21/28




BUNKER REMAIN ON BOARD

ATA / ATD

VESSELS NAME :

VOYAGE :

DATE :

PORT :

DRAFT

F : Mtr

M : Mtr

A : Mtr

MFO / IFO TANKS :

NO TANKULLAGE /

SOUNDINGVOLUME(KL / M3 )

TEMP(o C)

SGTANKS

VCFMETRIC

TON

TOTAL

MDO / HSD / MGO TANKS :

NO TANKULLAGE /

SOUNDINGVOLUME(KL / M3 )

TEMP(o C)

SGTANKS

VCFMETRIC

TON

TOTAL

All bunker tanks has been inspected and calculated together between :

PT. PERTAMINA (PERSERO) Chief Engineer :

Representative


22/28




SAILING ORDER

To : Master MT/TT/TB Date :

No :

Dear sir,

Please proceed to on after completion

of Loading/Discharging at , for Loading/Discharging as follows :

Cargo : Quantities : Destination

The complete information about next port will sent via telex if necessary.Please follow the instruction from Tanker Operation.

Yours trulyPT PERTAMINA (PERSER0)Representative


23/28




SHIP CONDITION

MT

Master / Chief Officer

( .. )

LAST PORT CONDITION FROM : ARRIVAL : REPLENISHMENT DEPARTURE TO:

DATE : DATE : DATE : DATE :

TIME : TIME : TIME : TIME :

BUNKER BUNKER BUNKER BUNKER

MFO : MT MFO : MT MFO : MT MFO : M

MDO : MT MDO : MT MDO : MT MDO : M

HSD : MT HSD : MT HSD : MT HSD : M

FRESH WATER FRESH WATER FRESH WATER FRESH WATER

BW : Tons BW : Tons BW : Tons BW : To

FW : Tons FW : Tons FW : Tons FW : To

DRAFT DRAFT DRAFT

Fore : Mtr FORE Mtr Fore :

After : Mtr AFTER : Mtr After :

TotalDistance

: N /Miles

PORT:

PELABUHAN

DATE :

TANGGAL


24/28




Statement Of Fact

(Ship Unreadiness and Readiness)

To whom it may concern

I the Master of MT/SS/TB. Call sign :Flag : DWT :

Declare that vessel is not ready on the date : hour :

(hours local time) In the position whileROB for MFO (180cst/380cst) : MT.

MDO : MT.

HSD : MT.

MGO : MT.FW : Ton.

Remarks :

Vessel is ready for :

Date : Hour : (hours local time)

ROB for MFO (180cst/380cst) : MT.

MDO : MT.

HSD : MT.

MGO : MT.

FW : Ton.

Remarks :

Port :

Date :Acknowledge

PT. PERTAMINA (PERSERO)Representative

Master MT /SS/ TB :


25/28




Statement of Reduce Rate

of Loading / Discharging


I, Master MT stated that, today,

date at port

at hours local time, as requested by The Loading Master,

,to temporary reduce discharging/ loading rate of cargo

from M3/ sec to M

3/ sec

from hours local time,

until hours local time.

due to :

Kindly sign and return the copy of this letter of acknowledgement.


.

Port of :

Date :


26/28




Statement of Temporary Stop

for Loading / Discharging


I, Master MT stated that,

today , date

In port at hours local time, as requested by

the Loading Master,Mr. ,to temporary stop

discharging/ loading cargo from hours local time,

until hours local time.

due to :

Kindly sign and return the copy of this letter of acknowledgement.


...

Port of :

Date :


27/28




TANKER TIME SHEET

STATEMENT OF ACTIVITY DATE HOURTOTAL

REMARKSPART TIME

Actual Time ArrivedBAnchor at Outer Bar

Pilot On BoardAnchor Up

AAnchor at Inner AnchorageFree Pratique Granted

BPilot On BoardAnchor Up

NOR TenderedNOR AcceptedFirst Line to Shore

AAll Made FastedCargo Hose Connected CCommenced Ballast / Deballast

ACompleted Ballast / DeballastCommenced Load / Disch (1)

A/C

Stopped Load / Disch order by Ship / ShoreResume Load / Disch (2)Stopped Load / Disch order by Ship / ShoreResume Load / Disch (3)Completed Load / DischReduced Load / Disch rate order by Ship / ShoreContinues to Agreement Rate Load/ Disch (1)Reduced Load / Disch rate order by Ship / Shore

Continues to Agreement Rate Load/ Disch (2)Reduced Load / Disch rate order by Ship / ShoreContinues to Agreement Rate Load/ Disch (3)Cargo Hose Disconnected C

Ships Paper & Cargo Document on Board B ROB Bunker (Metric Ton)

Commenced BunkerA

Grade Arrv. Repl. DepCompleted Bunker MFOCast Off

AMDO

Anchor at Inner Anchorage HSD

Pilot On Board B FWAnchor Up

ALO

Actual Time Departure / Sailed

SHORE FIGURE (BL / AR) SHIP FIGURE (AL / BD)GRADEKL Obs

KL 15CBbls 60FLTMT

TOTAL TIME FOR : SHIP (A) : AGENT (B) : SHORE (C) : PORT TIME HExplanation of Delay : LAYTIME USED H

From : To : : LAYTIME ALLOWED HFrom : To : : EXCESS TIME HFrom : To : :

Vessel Name : Port of : Next Port :

Flag : Date : ETA :

Master : Voy No. : Draft on Fwd Mean Aft

GRT : Last Port : Arrival :

DWT : B/L No. : Departure :

PT PERTAMINA (PERSERO) MT/ TTRepresentative MASTER


28/28




ULLAGE / SOUNDING - REPORT

M / T :

VOYAGE :

DATE :

PORT :

DRAFT

F : Mtr

M : Mtr

A : Mtr

TANK NOULLAGES /

SOUND*

(CM)

OBSERVEDTEMP

CARGO (oC)

GRADE REMARKSTEMP(

oC)

DENSITY 15oC

PORT

1

2

3

4

5

6

7

CENTER

1

2

3

4

5

6

7

STBS

1

2

3

4

5

6

7

Note: If any compartement used for ballast tank or empty, must be explained in the remarks column

.CHIEF OFFICER

Documents

Standard Formulir Aktivitas Kapal Di Pelabuhan