PBO G 04 F04 Receipt of document transmittal


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To : ____________ Attached please find_________copies of document. You are kindly asked to sign the receipt and keep the document properly.

S/N

Name of documents

Pages

Edition

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

Acknowledgment of Receipt on board

Acknowledgment of Receipt in Office

Date Receipt :

Master__________________________________

(Signature)

Vessel :_________________________________

Date Receipt :

Receiver :_______________________________

(Signature)

Division :_______________________________

DPA :_____________________

Note: To be completed every time and filed office's file.

To retain for 1 year.

Issue date: 03.11.2003/Rev. 00 PBO-G∗04-F04 Page: 1/1

RECEIPT OF DOCUMENT TRANSMITTAL

QSMS P-G∗04-F04 Rev. No.00



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