SHIPPER’S DECLARATION

9367/ADM/MUTU/X/2018

Note: This is not applicable if the cargo to be loaded requires a declaration under the requirements of SOLAS 1974,
Chapter VII/R4, MARPOL 73/78 Annex III/R4, and the IMDG Code Chapter 5.4 (Documentation).
This form meets the requirements of SOLAS 1974, Chapter VI, Reg 2 (for general cargo, cargo in units, cargo carried in
solid bulk) and the IMSBC Code, Section 4.2.

General Information
Shipper : PT. MULTI TAMBANGJAYA UTAMA Transport document number :

Consignee : TO ORDER Carrier: MV. VINALINES BRAVE

Name/means of transport : MOTHER VESSEL
Port/place of departure : TABONEO ANCHORAGE, SOUTH Instructions of other matters
KALIMANTAN, INDONESIA NOT TO VENTILATE HOLDS DURING LONG JURNEYS
Port/place of destination : ANY PORT(S) IN MAINLAND CHINA

Cargo Information
General description of the cargo (For solid bulk cargo – type of material/particle size)
Gross mass (kg/tonnes) : 43,000 MT Relevant special properties of cargo (eg highly soluble in
General Cargo : INDONESIAN STEAM COAL IN BULK water. For solid bulk cargo, see Section 4 of the IMSBC Code)
Cargo unit(s) : MT (METRIC TONNES) The cargo loaded on board are not harmful to the marine
Bulk Cargo : STEAM COAL IN BULK environment
Solid Bulk Cargo Information
BCSN : COAL
Specification of bulk cargo : Group of the cargo
Stowage Factor : 42 CUFT / MT – WOG (without guarantee) Group A and B*
Angle of repose : 28 - 33⁰ Group A*
Group B
Trimming procedures : BY DOZER / EQUIPMENT
Group C
If potential hazard – chemical properties* : MHB *For cargoes which may liquefy
This commodity is not considered a cargo which may liquefy during the voyage (Group A and Group A and B Cargoes)
The cargo is not considered liable to emit significant amounts of methane
The cargo is considered not liable to spontaneous combustion
*eg: class, UN number or MHB
Transportable moisture limit : N/A Additional certificate(s) (if required)
Moisture content at shipment : 12% - 14%
Sulfur Content at shipment : < 2.00 % Certificate of moisture content
EHS/HME (see chapter 2.10 and 2.9.3 of the IMGD Code and MARPOL Annex V) Cargo and transportable moisture limit
residues must be disposed of in accordance with MARPOL Annex V Weathering certificate
Exemption certificate
EHS/Marine Pollutant Yes No Other (specify):
Human Health Criteria Met Yes No Not available
Rubber/Plastic Yes No

Note: Human Health Criteria data may not be available only until 31 December 2014. From
1 January 2015 Human Health Criteria data must be available.
Declaration
I hereby declare that the consignment is fully and accurately described and the given test result and other specification are correct
to the best of my knowledge and belief and can be considered as representative for the cargo to be loaded.
Name/status, company/organization of signatory Place and date Signature on behalf of shipper
TELUK BETUNG,
th
PT. MULTI TAMBANGJAYA UTAMA 22 October 2018

Musyadat
Port Captain

FM-00-BDM-004, Rev. 00, 24-11-14