REPRESENTATION

VESSEL:

FROM

TO

ACCOUNT

CHARTERERS

OWNERS

DATE

PORT

ACCOUNT

ITEMS

QUANTITY

UNIT/COST

TOTAL COST

TOTAL

MASTER:

……………………….

PORT:…………………….

SIGNATURE:

……………………….

DATE:…………………….

SHOULD BE COMPLETED AND FORWARDED TO THE OFFICE BY COURIER AT THE END OF EACH MONTH.

ATLANTIC UNITED MARINE INC.

FORM / 4204

Safety Management System Manual - IMO Res. A. 741 (18)

Developed by

Date of Initial Issue

Chapter

: SMS Designated Person

: April 1998

: 14

Authorized by

Revision No / Effective date

Page

: Managing Director

: 3 / 07-99

: 1