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