M/S_______________________		Voy,____________			Port_______________			Date__________
Reg. No. ___________		IMO No. ____________
		Issued	Confirmation		Next Survey		Valid
No.	Name of Cert.	Date	Kind	Date	Kind	Date	Date	Remark
1	Ship's Registry
2	Class Cert. For Hull
3	Class Cert. For Machinery
4	Safety Construction Cert.
5	Safety Equipment Cert.
6	Safety Radio Cert.
7	Radio Station License
8	International Load Line
9	International Tonnage
10	IOPP Cert.
11	ISPP Cert.
12	Min. Maning Cert. and GMDSS
13	Exempt Deratting Cert.
14	Tonnage Due
15	Light Due
16	Port Clearance
17	Panama Canal Tonnage
18	Suez Canal Special Tonnage
19	Maritime Pollution Financial Responsibility
20	Cert. of Inspection on Crew Accommodation
21	Classification with Survey Report
22	Notice to Flag Slate
23	Cargo Gear Load test
24	Cert. For Carrying Danger.
25	Cert. For Solid Bulk Cargo
26	Refrigerating Cert.
27	Document of Compliance
28	Safety Management Cert.
29	Life-Raft Manufacturing Certificate
30	Life-Raft Annual Inspections Certificate
31	Owners' LP & IIP
32	Docking Survey
33	Propeller Shaft Survey
34	Oil Fired Boiler
35	Exhaust Gas Boiler
36	CO2 weight Inpection
37	CO2 Blowing Test
38	Direction Finder
39	Magnetic Compass
40	life Buoys
41	Life Boat
42	Steel Wire Change Ends
43	Air Box Airtest/2years
44	Breathing Apparatus
45	Fire fighting Equipment
Note1: New items may be added in next page, if necessary.				Captain ............................................................
Note2: To be completed every voyage and filed in both office's file and ship's file.					To retain for 5 years.