FORM / 5105

Vessel:

Port:

Voy.No:

Date:

ROB/OBQ Certificate

Tank No.

Oil

Free Water

Non Liquid

Total ROB/OBQ Volume

Dip cm

*

*

Volume

cub. m.

Dip cm

*

*

Volume cub. m.

Dip cm

*

*

Volume cub. m.

CuM

TOTALS

Remarks:………………………….……………………………………………………………………………..………………………………………………………………………………………………………………………

Date:

Draught

Time:

Fwd

Aft

Trim

________________________ __________________

for the Vessel Survey

ATLANTIC UNITED MARINE INC.

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

Developed by

: SMS Designated Person

Authorised by

: Managing Director

Date of Initial Issue

: July 1999

Revision No / Effective Date

: 1 / 07-99

Chapter

: 7

Page

: 1