NO:PSS/DOC/2021/TB000037 DOCKING ate a TB.ROYAL 1 PT. PANCARAN MARITIM TRANSPORTINDO.2 PT. PANCARAN SAMUDERA SHIPYARD ts ‘boo Gagok 7-20, (00 Kul, Kutt Ketanegar, Kabmentan Tm Inne eed Office: Menor Stu Sentra Ketage Coding 2. Boulevard Kelope Goding iA3 NOL Lon 6 Tel “62 21 29385701 Fax: 12 21 29985702 KETERANGAN DOCKING ‘Nomor TB0G37/SKD-ROYAL 1VPSSIX/2021 ‘Bersame surat ni menerangkan bahw ‘Nama Kapal ROYAL Pemiie/ Ovmer PT. PANCARAN MARITIM TRANSPORTINDO seris Tus Boat Cass aK Ukuran Utama Kapal Panjang (LOA) 235 Meter Tingsi (0) 27 Meter Lebar (8) 732 Meter GRTNRT 455. GT “Telah mesjalani docking repair digalengen kapal milk PT.Pancaran Samudera Shipyar, sebagai benkut apa! Masuk Galangan 22 Septemosr 202% ‘kapal Naik Dock 30 September 2021 ‘Kapal Turun Dock 19 OMtaber 2021 ‘Kapal Selesai Pekajaan pat Keluar Gatangan ‘Demikian kami sampaikan, dengan cogala hormat atasperhaton dan Kebijsksanaannys kami ucapkan terma kash ual Kartanegara, 19 Oktober 2021 PT PANCARAN SAMUDERA SHIPYARD ‘ANDRI SUKMA RAMADHAN, esd of Shioyerd2= PT. PANCARAN SAMUDERA SHIPYARD PANCARAN ae ge tat ane ences fat 2 povevara reign Gosia A3 NOI Lon! Te 16931 2828578) FOR 46221 29285702 BERITA ACARA (KAPAL SELESAIPERBAIKAN ) Pada hatin, Selasatanggal Semblan Bolas Bulen Oktober Tahun Due Ribu Dua Puuh Satu (19 Oktober 2021) yang betanda tangan Sbawah in 1 Nama [ANDRI SUKI RAMADHAN Jatetan Head of Shipyara Perusahaan PT Pancaran Samudera Shipyaré Dalam alin becindak untuk dan ats nama PT. Pancaran Samudere Shipyard untuk sanjuinya dsebut YARD a ‘Nama ALDY NUARYS slebatan Ouner Representatve Perusahaan PT Pancaran Martin Transporindo Dalam alin bertindak unt dan atas nama PT. Pancaran Mast Transpertingo, yang soanjutnya dsabut OWNER REPRESENTATIVE Dengan in menyatakan dengan sebenarny, Behwa YARD telah monyerahkan 1 (eau) unt kapal kopada OWNER REPRESENTATIVE, yang tl select dtaksanakan semua perbaikan/decking repar dengan deta-dataceboga:berkut a Nama Kepal ROYAL ‘Type Tus Boar Ukeran Panjang (LOA) 285 Motor Lebar (8) 732 Meter “Tinggi (O) 27 Meter GRTNRT 455 GT Mesin 2x 1000 HP ‘OWNER REPRESENTATIVE tlsh manoima penyetahan 1 (ctu) unit kapal da YARD, yang tlh elesaidisksaneksn semua perbakenidockng eparsesuaikesepakatan dalam repair Ist, ‘Demikion besa aca in buat dengan sebenamnya untuk dapat dipergunakan sebageimna meetiny vero OWNER REFRESENTATIVE PT: PANCARAN GAMUCERA SHIPYARD PT PANGARANMARITINTRANSPORTINOO =a Cpe ny ‘aNDRISUKMNA RAMADAN Lp nuany s Fado Sheva ner Roper2= PT. PANCARAN SAMUDERA SHIPYARD te PANCARAN noe 24 12 le et trees rer rte 5 bowievordKeope Godin A3 No.1 Lonel ely. +6221 25385783 Fox $6221 29285782 BERITA ACARA ( SERAH TERIMA DOCUMENT ) Pade har ini, Selasa tanggal Gemblan Beias Bulan Ottober Tahun Dua Ribu Dua Pulh Satu (19 Oktober 2021) {telah dserah terimakan document becupe + Docking Report TUG BOAT ROYAL 1 (Original) sebanyak: 1 Rangkap Nomar T80037/SKO-ROYAL 1IPSSOV2021 Yang Menyerankan ‘Nama BAMBANG siabatan Project Ofcer Perusahaan PT. Pancaran Samusera Shipyard Yang Menerima ALDY NUARY S ‘Owner Representative Perusahosn PT. Pancaran Maritim Transportind ‘Document telah dserahtermakan dengan konds! balk dn lengkap DDerikan beta acara ni Ibuat dengan sebenarnya untuk dapat dpergunakan sedageimana mestny vyaRo OWNER REPRESENTATIVE PT PANCARAN SAMUOERA SHIPYARD ST PANCARAN MARITIN TRANSPORTINOO 8 Nha eaupaud, ALDY NUARY Projet Ofteer Gner RepresentativePT. PANCARAN SAMUDERA SHIPYARD 4 toe Gogok R.2, to Kulu, Ruta! Kertonegara Kalmanta Timer, ices Head Ofc: Menara Stu sentra Keaga Ging, 4 Bouevor’ Kelopa Going (13 Ne. arto 6 Yep 162 21 29285701 Fo: s62 2429385702 CARA ( SERAH TERIMA TUG BOAT ROYAL 1) Pada arn, Seas tanggal Serban Beas Bulan Oktober Tahun Ove Ribu Dua Pluh Satu (19 Oktober 2021) yang betanda angan dbaweh 1 Name BAMBANG “abatan Project Oficer Perusahaan PT, Paneafan Samudera Shipyard ‘Dalam hain bertndak untuk dan sta nama PT. Pancaran Semudera Shipyard, Untuk selanjuinya asebut YARD 2 Nama ALDY NUARY 5. sabotan (urner Represantatve Perusahaan PT Pancaran Martin Transportnds Dalam alin bertncak unt dan ats nama PT. Pancaren Mastin Transperindo, yang selarjuinya debut OWNER REPRESENTATIVE [Dengan inimenyatakan dengan sabenarnya, bahwa YARD telah menyorahkan 7 (elu) un kanal kepada OWNER REPRESENTATIVE, yang tah Slesaldisksanekan semua perbakanisockng epar dengan data data aebogal berkut 3 Nama Kapa ROYAL’ Type TUGBOAT Ueuran Panjang (LOA) 205 Meter Lebar (8) 732. Meter Tinggi (0) 27 Meter GRTINRT 155 GT Mesin 2x 1000 HP ‘OVINER REPRESENTATIVE telah menerina penyerahan 1 (eau) unit kaa dari YARD yang telah sees daksenekan semua perbakan / ‘decking repar digalangan PT Pancoran Samudere Shipyard seaus Kesepaxatan dela ropa it ‘Adapun Kondii Kapa 1 Lambung/ Hull Kondei bak ( eles pengecatan) 2 sido shat Kondsi bak (eles pengecatan | 3 Deck ters! Kondsi bak (selesa pengecatan ) 4 Sater Prop Lengkap (Kandi Baik) 5 Stem Kamu LLengkep (Kond! Bak) 6 tale LLengkap (Kandel Bak) 7 Zink Anode Kondsi baru (43 pos) 8 BanDaprah LLengkep sekeing Tug Boat 8 Wine angkar LLengkap (Kons! Bal & Bisa dioperaskan ) Demian berta acara ini buat dengen sebenarmya unluk dapat cpergunakan sebagaimana mestinya vyaRO ‘OWNER REPRESENTATIVE PT, PANCARAN SAMUDERA SHIPYARD PT. PANCARAN MARITIM TRANSPORTINDO Project Oftcer= PT. PANCARAN SAMUDERA SHIPYARD = 1.408 Copok 20,120 Ky, uta Kertonegoe almatan Tn, ores PANCARAN ead Offle: Menara Stu sentra Kelp Godng Sater > 2 boulevard Keine Coding AY NO. Lert 6 Fel. £6221 29985701 FOX 6221 29385782 BERITA ACARA (FINAL INSPEKS!) Pada hari ni, Stasatanggal Sembilan Betas Bulan Oktober Tahun Dua Ribu Oua Puluh Satu (19 O¥toder 2021) TTelahdlakukan tna inspeksibersama pada TUG BOAT ROYAL 1 antaa pinak onner yang dhvakl oleh 3p. ALDY NUARY S: dan pinak ara yang ol wakilolgh Bp. BAMEANG, ‘Owner menyatakan bahwa pekerjaan pertaikan sudah selsai i lakukan sesusl dengan list pekerjan yang di Ssepakatiantara pak gaiangan PT. PANCARAN SAMUDERA SHIPYARD dan pinak ovner PT. PANCARAN MARITIM TRANSPORTINDO ddan kapal TUG BOAT ROYAL 1 dinyatakan layak untuk dloperacikan, DDomikan bots acara ini dibust dengan sebensmya untuk dapat dpergunakan sebageimene mestinya ‘YARD ‘OWNER REPRESENTATIVE PT, PANCARAN SAMUDERA SHIPYARD PT. PANCARAN MARITIM TRANSPORTINDO ALDYN Project Ooer ‘Owner Representative2 PT. PANCARAN SAMUDERA SHIPYARD PANCARAN Sect cee eer etinanereaeae ares bs a meer 4. Bowles Klopo Godin LAS NO. {Lento Tel. 28221 2938578) FOE: 10221 29385782 BERITA ACARA (Cleaning Void Tank ) Pada hal in, Setasa tanggal Sembilan Belas Sulan Oktober Tahun Dua Ribu Oua Pulun Satu (19 Oktober 2021) “elan seesailiaksanakan pekejaan cleaning pada pada area bulk cargo pad kapal TUG BOAT ROYAL 1 ‘Selah di lakukan pengecekan olen owner representative, maka area Chain Locker dan Bige area dayatatan berth DDemikian bets acre in ibust dengan sebenarnya untuk dapat dpergunakan sebagaimans mestny. yaRD = OWNER REPRESENTATIVE PT. PANCARAN SAMUDERA SHIPYARD PT. PANCARAN MARITIM TRANSPORTINDO “Games Project Officer ‘Owner Represontativeaw enka a en8a oe tug und avin sone rst seo ous aes So wares arava 044s svogont: u2r eLrwsow aL: sueiten avis yecCris Qraps NVeVoONve @ ORVLART ERTS WERTINET &Se INOW OOS 0s ‘08 su seebe deve 5 BAS ost RE 8888 2288 eee Efe G88Es8 z ggigegg go 2 8 8 & feeke ge spect wee t owt noea pew » na we 2 1 ese cor aa rose ” on wo tos sown wee ” co ‘xn003 ewvORNIHO wet i o st ‘noms oF T o sto H pou mwase ano toi Tish 8 ost ost "ma soneEvey Ree Q20EE 2 REE 22322 22 ‘eniaT “woe NeISINod somnen. ort t o St wor we rf o ome 2 ow wr a 8 wo > wo wx z 8 & some ot 1 & Stoo oo © oo osoagen soy mang spsety noisruowePT Pancaran Samudera Shipyard = ‘Los Gaga oe Kula Kuta Ketanegara REQUISITION for INSPECTION PANCARAN ‘and ACCEPTANCE FORM, [sui TEROYACI REFERENCE REQUEST No. = 1R/T8000037/001 lcuent PT. PANCARAN MARITIM TRANSPORTINDO PROJECT CODE 8000037 cuass 8K! INSPECTION/TEST DATE: 30-89-21 CATEGORY: NTERMEDIATE SURVEY INSPECTION/TEST TIME PROJECT No. REG.TO > QUALITY CONTROL DEFT. By PROJECT OFFICER eff. Drawing No. : ITEM TOBE INSPECTED : Shaft propeller bearing (Before perbalkan) Description - Shaft propeller to FWD & AFT bearing |- Rudder stock to neck bearing Pintle shaft to pintle bearing Please arrange for inspection/test to be performed on the following THOR APPICANE DESCRIPTION ReSUTT [conic ATER RSEETON [FIT-UP / WELD PREPARATION [sua weoiv wsrecTOnSTRUCURE® Ion estRucTVE TEST WOT, RT. PLP. UT, © [asua mat seecr saver JLEAK TEST (wwnnnnnnon fase lores Inspection Result Comments / Recommendation propriate requirement a aaa ee | an a wt ee ee fla NAME. BAMBANG THA PAMBUDI M. IQBAL RACHMAN ALDY NUARY S_Ba PT Pancaran Samudera Shipyard REQUISITION for INSPECTION 1. Lo Gone a Krarge and ACCEPTANCE FORM EANG ARAN SHIP. ‘TB.ROYAL 1 REFERENCE REQUEST No. : IR/TB000037/002 cueNT —_: Pr. PANCARAN MARITIM TRANSPORTINDOFT. PANCARAI PROJECT CODE + 8000037 CLASS BKI INSPECTION/TEST DATE: 30-9-21 [CATEGORY : INTERMEDIATE SURVEY INSPECTION/TEST TIME PROJECT No. REG. TO > QUALITY CONTROL DEFT. by PROJECT OFFICER [Reff. Drawing No. : ITEM TOBE INSPECTED : Shaft propeller bearing (After perbalkan) Description - Shaft propeller to FWD & AFT bearing - Rudder stock to neck bearing -Pintle shaft to pintle bearing Please arrange or ingpection/est to be performed onthe following Tr ARCANE DESCRIPTION TUT IncoMNG MATERA WSPECTION a / Wei Pep anaron ~ stato nspecnon STRUCTURE Ion bésrnucrve res Wo MP Pru [sua nas wsPecTonsTUCTURE) ) Ba a ‘Accepted inspection Result Comments / Recommendation -Resutt at Attachment + Choose the appropriate requirement REQUEST BY. INSPECTION BY. ROWING BY, “APPROVED BY. PROIECT OFFICER {QUALITY CONTROL PLANNER. OWNER REP. DATE alee wl | & NAME BAMBANG TTHAM PAMBUDI M IGBAL RACHVAN. ALDY NUARYS> _ PT Pancaran Samudera Shipyard REQUISITION for INSPECTION PANCARAN a toscuios tae enaee and ACCEPTANCE FORM. sHiP TeROWACT REFERENCE REQUEST No, > /THOO0O57/008 cuent —_: Pr. PANCARAN Mani TRANSPORTINDO PROJECT CODE 78000037 cuss: oxi INSPECTION/TEST DATE: 30-9-21 carecory. : wvtenMeiare sunver INSPECTION/TEST TIME PROJECT No REQ. TO_= QUALITY CONTROL DEPT ey PROJECT OFFICER Ref. Drawing No. TEM TOBEINGPECTED ; UT PLAT BOTTOM TOPSIDE AREA UNDER WATER Description UT Pat lambung kapal Please arange for inspection/test tobe performed on the flowing THR APPLE DESCRIPTION REUT [INCOMING MATERIAL INSPECTION F-UP / WELD PREPARATION VISUAL / WELDING INSPECTION (STRUCTURE)* INOW DESTRUCTIVE TEST (NDT): RT, MPI, PT, UT, * |visuaL / FINAL INSPECTION (STRUCTURE)* |LEAK TEST (Air Test 7 Bar) JoreRs (.... Inspection Result Comments / Recommendation -Report on PT PINTEK * Choose the appropriate requirement een eaZS prpancaran Samudera Shipyard PANCARAN !0#CazttonKuu ttt teranena REQUISITION for INSPECTION and ACCEPTANCE FORM. SHIP TBROYALT lcuenr PT. PANCARAN MARITIM TRANSPORTINDO Iciass : BK! CATEGORY: INTERMEDIATE SURVEY REFERENCE REQUEST No. PROJECT CODE INSPECTION/TEST DATE INSPECTION/TEST TIME PROJECT No. + 1R/T8000037/004 ‘78000037 + 10/10/2021 REQ. TO ‘QUALITY CONTROL DEPT. By : PROJECT OFFICER Reff. Drawing No. : TEM TOBE INSPECTED : Anchor chain Description Joining shackle, swivel , common link, & kenter shackle Please arrange for inspection/test to be performed on the following TIOKIFAPPUCABLE DESCRIPTION. RESULT [INCOMING MATERIAL INSPECTION FT-UP / WELD PREPARATION | VISUAL / WELDING INSPECTION (STRUCTURE)* Non DestRUcTive TEST (NOM) RF, MPL PT, UT, * visu / FINAL INSPECTION (STRUCTURE|* [lean TEST (air Test 7 B00) ee OTHERS (tMeasurement check) [inspection Result Comments / Recommendation : -Resutt at Attachment * Choose the appropriate requirement mee TERETONET mom TORT FROLECT OFFICER | —GUATTY OMT rer SRE ate signature i lla NAME, BAMBANG ILHAM PAMBUDI M. IQBAL RACHMAN "ALDY NUARY Sa PT Pancaran Samudera Shipyard PANCARAN !!9#6sonku fut teranerra REQUISITION for INSPECTION and ACCEPTANCE FORM Reff. Drawing No. : (SHIP TBROVALT REFERENCE REQUEST No. _: 1R/TBO00037/005 IcuenT PT. PANCARAN MARITIM TRANSPORTINDO PROJECT CODE : 18000037 icuass : OKI INSPECTION/TESTDATE — : 10/10/2021, JCATEGORY : INTERMEDIATE SURVEY INSPECTION/TEST IME PROJECT No. REG. TO = QUALITY CONTROL DEPT. By : PROJECT OFFICER Description ITEM TOBE INSPECTED : - Dial alignment (GAP & SAG) Tail shaft flange to gearbox flange Please arrange for inspection/test to be performed on the following “ssa a ar rammemmenre -- Fron neron = : fet pearronetee =| icecream isi eco es mesa a Scene ee ean pa ores ET emenomaret “Teas pea RE Se — RoR — ae —[ a sme ee serine j \he fhe NAME BAMBENG TLHAM PAMBUDI ‘M. IQBAL RACHNVAN, ALDY NUARY Sa PT Pancaran Samudera Shipyard REQUISITION for INSPECTION e 1 Lo aga on Kl tat eran and ACCEPTANCE FORM SP TeROWAT REFERENCE REQUESTNe.: 1R/TB000037/006 CLIENT PT. PANCARAN MARITIM TRANSPORTINDO PROJECT CODE 78000037 cass xi INSPECTION/TEST DATE: 1/10/2021 JcaTEGORY INTERMEDIATE SURVEY INSPECTION/TEST TIME PROJECT No. REG. TO: QUALITY CONTROL DEPT. By + PROJECT OFFICER Ref. Drawing No. [TEM TOBE INSPECTED: Tail ShafePS Description -Penetrant test Please arrange for inspection/test to be performed on the folowing : Tec mPucARLE DESCRIPTION RESULT NCONING MATERIAL INSPECTION FIT-UP / WELD PREPARATION [VISUAL / WELDING INSPECTION (STRUCTURE)* |NON DESTRUCTIVE TEST (NDT): Ram PT, UH * [VISUAL / FINAL INSPECTION (STRUCTURE)* |LEAKTEST (Air Test 7 Bar) eee [OTHERS (Measurement check) Inspection Result Comments / Recommendation |-Report on PT PINTEK REQUEST RY INSPECTION Wy ANOWING BY "APPROVED BY PROIECT OFFICER ‘QUALITY CONTROL PLANNER ‘OWNER REP Dare SIGNATURE } fi I la Ly hs i NAME BAMBANG TORT M. JOBAL RACHMAN ‘ALDY NUARY SZS rrrancaran samuderaShipyrd CapAan €eemkirtasttstnen REQUISITION for INSPECTION and ACCEPTANCE FORM [SHIP = TEROYALI ICueNT PT. PANCARAN MARITIM TRANSPORTINDO icLass : BKI CATEGORY: INTERMEDIATE SURVEY REFERENCE REQUEST No. PROJECT CODE INSPECTION/TEST DATE INSPECTION/TEST IME PROJECT No. 1R/18000037/007 "78000037 1/10/2021 REQ.TO = QUALITY CONTROL DEPT. By : PROJECT OFFICER Reff. Drawing No. : TEM TOBE INSPECTED, Description -Dial deflection shaft P/S Tail Shake PS Please arrange for inspection/test to be performed on the following TICK APPUCARLE DESCRIPTION, RESULT [INCOMING MHATERIAL INSPECTION Ft-UP / WELD PREPARATION \iSuAL/FIWAL INSPECTION (STRUCTURE)* Sut / WELDING INSPECTION (STRUCTURE)® NON DESTRUCTIVE TEST (NOT): RT, MPL PT, UT, = eax res (ar Test 7 ar) z OTHER. car a | assented Inspection Result Comments / Recommendation : - Result on attactment 7 Choose the appropriate requirement REQUEST 8, TNSPECTON TOWNGW. APPROVED BY. FROJECT OFFICER | QUALITY CONTROL PLANNER OWNER REP. oATE SIGNATURE ?. Ub Klas NAME BAMBANG ILHAM PAMBUDI M.QBAL RACHMAN. ALDY NUARY S-2 prancaran Samudera si REQUISITION for INSPECTION PANCARAN ‘Ise etait eranegs and ACCEPTANCE FORM [saIP TEROVALT REFERENCE REQUEST No, > 1R/TB000037/008 ICLIENT —_: PT. PANCARAN MARTIM TRANSPORTINDO PROJECT CODE + 18000037 Icuass ext INSPECTION/TEST DATE — : 20/9/2024 JCATEGORY : INTERMEDIATE SURVEY INSPECTION/TESTTIME — ; 09.00- 10.00 WITA PROJECT No. REQ.TO > QUALITY CONTROL DEPT, By + PROJECT OFFICER Reff. Drawing No. TEM TOBE INSPECTED Description -Penetrant test Propeller PS Please arrange for inspection/test to be performed on the following : DESCRIPTION RESULT, INCOMING MATERIAL INSPECTION FT-UP / WELD PREPARATION [VISUAL / WELDING INSPECTION (STRUCTURE)? INON DESTRUCTIVE TEST (NOT): RF; MP, PT, | _|LEAK TEST (aie Test 7 Bar) OTHERS (. |visUAL / FNAL INSPECTION (sTRUCTURE)” [inspection Result Comments / Recommendatior |- Found two defect crack (10.30 wita already repaired) |- Report on PT. PINTEK * Choose the appropriate requirement oe eae [aac tron cae [ara pon aT. a a mer ae ; seouarne : Uke lla NAME BAMaANG TeRAR TH TQBAL RACHIMAN ‘RIDY NUARYSZS pr Pancaran Samudera Shipyard REQUISITION for INSPECTION PANCARAN #0#Gatattoauaukuseranepare ‘and ACCEPTANCE FORM [SHIP ‘TB.ROYAL | REFERENCE REQUEST No. 1R/TB000037/009° CLIENT: FT. PANCARAN MARTIM TRANSPORTINDO PROJECT CODE ‘75000037 CLASS BKI INSPECTION/TEST DATE 10/10/2021 lcaTEGORY : INTERMEDIATE SURVEY INSPECTION/TEST TIME PROJECT No. REG. TO > QUALITY CONTROL DEPT. ay PROJECT OFFICER [Reff. Drawing No. ITEM TOBEINSPECTED Valve Description Us KEKEDAPAN Please arrange for inspection/test tobe performed onthe following : "HOR APPUCABLE DESCRIPTION RESULT TicowN WATERAL SPECTON JFIT-UP / WELD PREPARATION JMSUAL / weLoin InsPEcrion(TRUCTURE DESTRUCTIVE TEST (NET: F-MBP,* [ HMSUAL/FvaL nsPecrion stRUCTURE} everest tro tex) formers. n ~~ Accepted inspection Resuit Comments / Recommendation - Result on attactment * Choose the appropriate requirement dust ud tha NAME, BAMBANG TLHAM'PAMBUDI M. IQBAL RACHMAN ‘ALDY NUARY SPT Pancaran Samudera Shipyard 2 REQUISITION for INSPECTION and ACCEPTANCE FORM. PANCARY “sreumtsentemtasermeas [stir TBROYALI REFERENCE REQUEST No. _: 1R/TB000037/010 IcuienT PT. PANCARAN MARITIM TRANSPORTINDO PROJECT CODE : 7000037 Jcuass Bk INSPECTION/TEST DATE: 10/10/2021, ICATEGORY : INTERMEDIATE SURVEY INSPECTION/TEST TIME PROJECT No, [REG TO ‘QUALITY CONTROL DEPT. lev + PROJECT OFFICER [Reff. Drawing No. [TEM TOBE INSPECTED : Propeller PS Description - Balancing Please arrange for inspection/test to be performed on the following TIC APPUCADLE DESCRIPTION RESULT [INCOMING MATERIAL INSPECTION LUP / WELD PREPARATION VISUAL / WELDING INSPECTION STRUCTURE)" INON DESTRUCTIVE TEST (NDT): RE-a4al Pr, UE |VsuAL/ FINAL INSPECTION (sTRUCTURE)* LeAKTEST(Hvdrotest) OTHERS (. [inspection Result Comments / Recommendation Result on attactment. © Choose the appropriate requirement See | see [poe [are NAME BAMBANG ILHAM PAMBUDI M. IQBAL RACHMAN. ‘AUDY NUARY SZS prpancaransamusera shipyard PANCABAN 1100 Gust ton uu ka Keranegra REQUISITION for INSPECTION and ACCEPTANCE FORM. [SHIP 7 TEROVALL REFERENCE REQUEST No. 1R/TB000037/011 ICLIENT —_: PT. PANCARAN MARITIM TRANSPORTINDO PROJECT CODE : 18000037 class : KI INSPECTION/TEST DATE: 10/10/2021 |CATEGORY : INTERMEDIATE SURVEY INSPECTION/TEST TIME PROJECT No, REQ. TO = QUALITY CONTROL DEPT. By PROJECT OFFICER Reff. Drawing No. : TEM TOBE INSPECTED: _ MAGGER TEST ELEKTROMOTOR DAN GENERATOR Description Please arrange for inspection/test to be performed on the following : TOKE APPUCABLE DESCRIPTION. RESULT niCOMING MATERIAL INSPECTION [FUP / WELD PREPARATION [sua / WELDING INSPECTION (STRUCTURE)* JMSUAL /FINALINSPECTION (STRUCTURE)* LEAK TEST (Air Test 7 JNOn DESTRUCTIVE TEST (NDT): RT, MPL PT, UT, * Joris... Accepted Inspection Result Comments / Recommendation - Report on PrPINTEK 7 Choose the appropriate Tequrerent REQUEST TSCTON GY ROWER TROVE ProikcrofnicéR | — QUALITY CONTROL ANNE OWNER EP DAE SIGNATURE (hae lg Y \ WANE TAMBING THA PMU | Wr TOBAT RACHIAN IDYNURAYSB PT Pancaran Samudera Shipyard 5. na Gaga Loa Kulu Kuta Kertanegara REQUISITION for INSPECTION and ACCEPTANCE FORM \LINSPECTION (STRUCTUF JOTHERS (.. SHIP + TBROYAL1 REFERENCE REQUEST No. + IR/TBO00037/012 ICLIENT : PT.PANCARAN MARIIM TRANSPORTINDO PROJECT CODE 8000037 cuass xi INSPECTION/TEST DATE 10/8/2021 | | feareconr : ivterwepure suave INSPECTION/TESTTIME | PROJECT No. (REQ. TO > QUALITY CONTROL DEPT | | fev : PROJECT OFFICER | | [pet Orewing No. : ITEM TOBE INSPECTED IPA AIR VENT HEAD FOT FWTSWT, PIPA UDARA SLOP TANK TFT Description a.cek welding Please arrange for inspection/test to be performed on the following : Te AC DESCRIPTION RESULT L | _[INCOMING MATERIAL INSPECTION me a 7 4 eo [VISUAL / WELDING NON (STRUCTURE|* x 2 m Accepted /ETEST (NDT): RT, MPL PT, UT, © inspection Result Comments / Recommendation : ee Ke * Choose the appropriate requirement REQUEST BY TRSPECTONGY. ROWING DY APPROVED BY PROJECT OFFICER | QUALITY CONTROL PLANNER OWNER REP, DATE ] SIGNATURE ( Lad ON NAVE BAMBANG | 1LHAw BAMBUDT_| Ww: BAL RACHMAN TAIBY NUARYSZS __prPancaran Samudera Shipyard REQUISITION for INSPECTION PANCARAN ‘12#Gektos kul ut etan ‘and ACCEPTANCE FORM RADIA AD (SHIP TBROYALT REFERENCE REQUEST No, © 1R77B000037/013 CLIENT PT. PANCARAN MARITIM TRANSPORTINDO PROJECT CODE : 78000037 IcLass 2 BKI INSPECTION/TEST DATE CATEGORY: INTERMEDIATE SURVEY INSPECTION/TEST TIME PROJECT No. REQ. TO: QUALITY CONTROL DEPT. ey : PROJECT OFFICER Reff. Drawing No. TEM TOBE INSPECTED; DUDUKAN PUSSER TUG Jo.Cek welding Please arrange for inspection/test to be performed on the following : TOK IF APPLICABLE DESCRIPTION RESULT INCOMING MATERALNSPECTON [ur wen pacpanarion MSuAt/wevoiwspecriow (sTAUCTORE® hon DESTRUCTIVE TEST (NEN) AT, MT, UT,* \WSuAL FNAL WsPécrion GTRUCTUREY Inspection Result Comments / Recommendation = “a as 7 Choose the appropriate requirement REQUEST 8. —_[ —NGPECTIONY. ROWING. APPROVED EY] PROJECT OFFICER | QUALITY CONTROL PLANNER OWNER REP. DATE y | a Tos WANE BAMBANG | “LHANTPaMBUGT |W TOBAL RACHMMAN IBY NUARYSZS PrPancaran Samudera Shipyard REQUISITION for INSPECTION PANCARAN 1122 G2eLos Kuta Keraregre and ACCEPTANCE FORM Sana [SHIP TB.ROYALI REFERENCE REQUEST No. 1R/TB000037/013 ICLIENT PT. PANCARAN MARITIMTRANSPORTINDO PROJECT CODE : 78000037 Iciass : BKI INSPECTION/TEST DATE CATEGORY: INTERMEDIATE SURVEY INSPECTION/TEST TIME PROJECT No. REQ TO; QUALITY CONTROL DEPT. By PROJECT OFFICER Reff. Drawing No. ITEM TOBE INSPECTED: Tangga maindeck P/5, Tangga 2nd deck P/S Description la.Cek welding Please arrange for inspection/test to be performed on the following : THOKIF APPLICABLE DESCRIPTION RESULT INCOMING MATERIAL INSPECTION (7 Jerr-ur/weio prePararion i VISUAL / WELDING INSPECTION (sTRUCTURE}* Accepted JNON DESTRUCTIVE TEST (NOT): RT, MPILPT,UT, * VisuAL/ FINAL INSPECTION (sTRUCTURE}® LeaK Test (ar OTHERS ( Inspection Result Comments / Recommendation lal Welding check ok y * Choose the appropriate requirement REQUEST BY. INSPECTION BY. KNOWING BY. ‘APPROVED BY. PROJECT OFFICER | QUALITY CONTROL PLANNER, ‘OWNER REP. DATE NAVE BAMBANG | TIHAM PAMBUDI_| WV IQBAL RACHMAN ADDY NUARYSZS PrPancaran Samudera Shipyard REQUISITION for INSPECTION PANICARAN * 120 Cosshtoe kaka Keranegnre and ACCEPTANCE FORM. [SHIP + TRROYALT REFERENCE REQUEST No. + 1R/7B000037/014 CLIENT PT. PANCARAN MARITIMTRANSPORTINDO PROJECT CODE : TB000037 CLASS BI INSPECTION/TEST DATE 09/10/2021 CATEGORY : INTERMEDIATE SURVEY INSPECTION/TEST TIME + 09,00 - 11.00 WITA PROJECT No. t REQ TO: QUALITY CONTROL DEPT. By PROJECT OFFICER [Reff. Drawing No. : [ITEM TOBE INSPECTED; DUDUKAN WINCH JANGKAR, STOPPER RANTAI JANGKAR, COVER WINCH Description Welding check Please arrange for inspection/test to be performed on the following : nay oa DESCRIPTION TEU icone MATERNAL REPECTON JFIT-UP/ WELD PREPARATION _ VISUAL / WELDING INSPECTION (STRUCTURE)* Accepted Now DESTRUCTIVE TES (NOT, ML PT UT * [MSuAc/FNALinspecrioN sraUcTURE [EAKTEST (Test? 86) orien (Measurement chee) Inspection Result Comments / Recommendation : {Terdapat Join antar siku yang kurang pengelasan Diperbaiki 10/10/2021, * Choose the appropriate requirement REQUEST BY. INSPECTION BY. KNOWING BY. "APPROVED BY. PROJECT OFFICER | QUALITY CONTROL PLANNER, ‘OWNER REP. DATE ae Wife NAME BAMBANG ILHANTPAMBUDI ‘M. IQBAL RACHMAN, ‘ALDY NUARY S.ZS prPancaran Samudera Shipyard PANCARAN “i stetons terre REQUISITION for INSPECTION and ACCEPTANCE FORM. SHIP + TB.ROYAL1 REFERENCE REQUEST No. ‘IR/TBO00037/015 Cai Se wees ae eee Ce eaee es eect ee RETO > A SONROCOT Sieh ones ee ER TOREEPETED COVER OER EW ROO hea Please arrange for inspection/test to be performed on the following. “susaranee scent =n [1] _NCOMING MATERIAL INSPECTION [1 [rrur/ wet PReParaTion SE a ——— al a ee et psn oe inspection Result Comments / Recommendation : Sas aaa eee ses AE SRS a ome SS ' ae du Hla a2 PT Pancaran Samudera Shipyard J. Lo Gaga Loe Kulu Kuta Kerang REQUISITION for INSPECTION PAN ‘and ACCEPTANCE FORM SHIP 7 TBROYALT REFERENCE REQUEST No. + 1R/¥8000037/016 ICLIENT _—: PT. PANCARAN MARITIM TRANSPORTINDO PROJECT CODE : 78000037 Iclass =: BK INSPECTION/TEST DATE JcATEGORY : INTERMEDIATE suRVEY INSPECTION/TEST TIME PROJECT No. [REQ TO: QUALITY CONTROL DEPT. By PROJECT OFFICER eff. Drawing No. : ITEM TOBE INSPECTED ; _ MATRAS TOWING Description - Check welding Please arrange for inspection/test to be performed on the following : TTOXIFAPPUCABLE DESCRIPTION RESULT INCOMING MATERIAL INSPECTION aie Fr-Up / WELD PREPARATION me - ]VISUAL / WELDING INSPECTION (STRUCTURE) Accepted [inspection Result Comments / Recommendation > * Choose the appropriate requirement REQUEST BY, INSPECTION BY_[ RNOWING BY, APPROVED BY PROIECT OFFICER | QUALITY CONTROL PLANNER OWNER REP. DATE t SIGNATURE (| ‘ . A NAME BAMEYNG ILHAM PAMBUDI_| Mi JQBAL RACHMAN. ALDY NUARYS2 PT Pancaran Samudera Shipyard REQUISITION for INSPECTION PANEABAN 1 Loa Gagek Loa Kul Kuta Kertanegara and ACCEPTANCE FORM [SHIP + TBROYALI REFERENCE REQUEST No. © 1R/TB000037/017 ICuENT PT. PANCARAN MARITIM TRANSPORTINDO PROJECT CODE : 78000037 IcLass : BK INSPECTION/TEST DATE : CATEGORY: INTERMEDIATE SURVEY INSPECTION/TEST TIME (09,00 - 10.00 WITA PROJECT No. REQ. TO; QUALITY CONTROL DEPT, By PROJECT OFFICER Reff. Drawing No. : Description [SW AE&ME P/S PIPA FW AKOMODASI TEM TOBE INSPECTED: Piping engine Room Please arrange for inspection/test to be performed on the following TIOKIF APPLICABLE DESCRIPTION TST T InCOnING WATERATNSPECTON FT / WELO PREPARATION | {esuat/weioine wsrecrion (swucTUREP ‘Acopted NON DESTRUCTIVE TEST (NOT) BM, FT, VISUAL / FINAL INSPECTION (STRUCTURE) JeaKrest ar est? 8a) omer. a Inspection Result Comments / Recommendation * Choose the appropriate requirement REQUEST BY TRSPECTION BY. ROWING EY. APPROVED BY PROJECTOFFICER | QUALTY CONTROL PLANNER ‘OWNER REP OnE SIGNATURE E (Wl Ala WAVE BAMBANG | HAM PAMGUBT_| —NLTGBAL RACHMAN AIDY NUARTSPT Pancaran Samudera Shipyard PANCARAN, l0¥Stskton ku Kut Kerareea REQUISITION for INSPECTION and ACCEPTANCE FORM SHIP TB.ROYALI REFERENCE REQUEST No. 1R/78000037/018 JcueNT PT. PANCARAN MARITIM TRANSPORTINDO PROJECT CODE 78000037 Ictass : BKI INSPECTION/TEST DATE ICATEGORY : INTERMEDIATE SURVEY INSPECTION/TEST TIME 13.00 - 16.00 WITA, PROJECT No. [REQ TO: QUALITY CONTROL DEPT. lev : PROJECT OFFICER Reff. Drawing No. ITEM TOBE INSPECTED: PIPA FIRE PLAN P/S Description Please arrange for inspection/test to be performed on the following. TIOKIF APPLICABLE DESCRIPTION RESULT ORANG RATER SPE FUP / WELD aePaRATON |VISUAL / WELDING INSPECTION (STRUCTURE) OW DESTRUCTIVE TEST(NT) iy T* MASUAL/ FNAL NSPECTION(TRUCTURE [inspection Result Comments / Recommendation = > é te * Choose the appropriate requirement 7 sous f id lh Ta aB PT Pancaran Samudera Shipyard REQUISITION for INSPECTION PANCABAN Mo ciotoekaitisiteteatinaen Ting hie and ACCEPTANCE FORM. si TB ROYAL REFERENCE REQUESTNo, = 1R/TB000037/019, lcuenr PT. PANCRAN MARIIM TRASPORTINDO PROJECT CODE ‘79000037 lcuass x INSPECTION/TEST DATE: 10/2/2021 lcaTeGonY BLASTING INSPECTION/TESTTIME —: 99.001T PROJECT No. REQUESTTO Dep. Quality Control SECTION ‘oaZas By DESIGNATION ITEM TOBE INSPECTED: BLASTING Description Reff. Drawing No. | BLASTING UNDERWATER |- BLASTING TOPSIDE & EXTERNAL BULWARK | BLASTING MAINDECK. Please arrange for inspection/test tobe performed on the following: TICKF APPLICABLE DESCRIPTION eu [ROM MATER RSPETTON reansFenc Wear earew nuMoeK ur wetoenePanarion LOING INSPECTION (STRUCTURE TEST(NOTE:RTLMPL FUT * sun. ena nerecronraUcTURE res vac TST [vsuAc este & PANTING inspection Result Comments / Recommendation Founded some flash rust/rusty area and area need to grinding on minor area, ‘QCfuly advice to do repair and re inspect is required. Re inspection and final inspection has conducted together Owner rep's, a5 the results satisfying 7 Choose the appropriate requirement ‘DATE, 1 \ v iI Sine as | kl NAME BAMBANG SI ROSRWANTO_ MJQBAL RACHMAN, ‘ALDY NUARY S-PT Pancaran Samudera Shipyard 2 REQUISITION for INSPECTION NI shoe aga rl! artaneprattnanan Tm rae and ACCEPTANCE FORM [smir TeROVALT REFERENCE REQUEST No, 1R/TB0000377020 lcuent PT. PANCRAN MARITIM TRASPORTINOO PROJECT CODE "78000037 lcuass en INSPECTION/TEST DATE: 10/2/2021 lcaTeGoRY PAINTING INSPECTION/TEST TIME: 09.00 LT PROJECT No. REQUESTTO Dep.Guality Control “SECTION ‘GATaC lev DESIGNATION [vem TORE WsPECTED PAINTING Description eff. Drawing No. - BLASTING UNDERWATER - BLASTING TOPSIDE & EXTERNAL BULWARK - BLASTING MAINDECK. Please arrange for inspection/test to be performed on the folowing : TICK IF APPLICABLE DESCRIPTION RESULT [icone waren PECTIN leansrenns nea Warcn mae F-UP / wei PaePaRaON nck cava msPecTiON sun. /wexomcinsrerion GrRveTORE |NON DESTRUCTIVE TEST (NOT}: RT, MPI PT, UT, * "sua / Fnac nsrEcron sravcrun* ~ [an es van res os st roRO TEST sua LATING PANTING [inspection Result Comments / Recommendation > Founded some miss coat low DFT, paint sagzing & water matk on minor area, {QC fully advice to do repair and re inspect is required. Re inspection and final inspection has conducted together Owner reps, as the results satistVng ¥ Choose the appropriate requirement —— ae ee = = _ a: “ = : — ae ‘ , (dd lla NAME BAMBANG SI ROSIS IRWANYO M.IQBAL RACHMAN, “ALDY NUARY SDoe. No, Sea chest ate val Gate valve sea chest s LEAK TEST Revision | BONGARON REPORT ire Wessel Ta, ROYAL Date of inspection "4 Oktober 2021 lueaktest = [2] atest Ei] vororest Oo omer « ) HOLD TIME 10 Minute lPRESoURE © Bar RSPECTED EY. REREDEY TARVER ip. fla suxadtbaMeuoL antronts 5) AC nspeetor Project Omar OwnerB= MAIN CODE — = VESSEL TBROYAL 1 PANG, AF ae AN JARTICLE SHAFT DEFLECTION NO. ORDER CONDITION: AFTER REPAIR | ee oroxtoserze1 {unit STARBOARD & PORT SIDE ANGLE ROTATION " om + w2 ws ows ows ows apne a 0 O [|_Forwaro “69:1. = -o4- —p BE ‘i = = a ~ ROLLER BEARING ROLLERBEARING = PORTSIDE STARBOARD SIDE ANGLE DIAL ANGLE DIAL ROTATION | 1 2 3 4 5 6 ROTATION | 1 z 3 4 5 6 o 0 0 0 o 0 0 o 0 0 0 o 0 0 Cc +0,09] +0,06/+0,05] 0 | +0,05] 40,06) CH 40,21] 40,2 -0,08 | +0,08 90" +0,09| +0,14 | +0,08 | -0,02 | +0,08| +0,24] 90" 40,19 OTE] Ex 0,1 | +0,22| 135" 0,08] +0,19] +0,03] -0,06 | +0,11] +0,3 135" 40,01 | +0,05] -0, 0,13 | +0,27) 180" #0,06 | +0,21 | +0,02 | -0,02 | +0,21| +0,38) 180" 0,22] 01 0,09 | +0,33] 25° +001} 40,1 | +0,03]-0.01] 0 | +03 225" 0,44 | -0,25 | + 0,04 | +036) 270" 0,01 | +0,01 | +0,03} -0,07 | -0,05 | +0,14} 270" -0,48 | -0,32 40,02] +0,141 315" 0,01 -0,02 | +0,02] -0,09 | -0,12 | +0,02] 315" 0,28 | -0,19 saat 0,08 | -0,04 | +0,03 Remark INSPECTED BY, VERIFIED BY, hs IL “OWNER SURVEYORaz MAIN CODE — = VESSEL ‘TBROYAL I PANCARAN ARTICLE BALANCING PROPELLER NO, ORDER CONDITION: AFTER REPAIR eeaeae T0ct24 luni STARBOARD & PORTSIDE PORT SIDE STARBOARD SIDE ROTATED RESULT ROTATED RESULT T [Blade 1 in bottom BALANCE [Blade 1 in bottom BALANCE [Blade 1 & 2 paraliel in botiom | BALANCE [Blade 1 & 2paralelin bottom | BALANCE lBtade 2 in bottom BALANCE [Blade 2 in bottom BALANCE [Blade 28 3paraelin bottom | BALANCE [Blade 2 & 3 paralelin botom | BALANCE [Blade 3 in bottom BALANCE [Blade 3in bottom BALANCE [Blade 3 & 24paralelin bottom | BALANCE [Blade 3 & 24paralel in bottom | BALANCE Btade 4in bottom BALANCE Blade 4in bottom BALANCE REVIEW BY, gM INSPECTED BY, VERIFIED BY,Zs IMAIN CODE = VESSEL PANCARAN SAMUDERA SHIPYARD [ARTICLE TB ROYAL I CLEARANCE SHAFT PROPELLER NO. ORDER CONDITION: AFTER eee : sdoctat unit : STARBOARD & PORT SIDE PORTSIDE STARBOARDSIDE ‘AFTER: FORWARD: AFTER FORWARD 005 065 | 03 } 05 o7 [or 02 = | @ @ | @ Noe REVIEW BY, INSPECTED BY, VERIFIED BY, la “OWNER SURVEYOR——=— Es | ————* MAIN CODE | = VESSEL TBROYAL 1 PANCARS AN IARTICLE RUDDER SHAFT CLEARANCE NO. ORDER |CONDITION BEFORE cee 30-Sep-21 UNIT STARBOARD & PORT SIDE Q oo Rudder Sk: 113 eee + Max clearance: 3.013 mm a norromenme @Bottom Pintle: 101 ean ae Max clearance: 5.01. mm BOTTOM PRTLE, PORTSIDE STARBOARDSIDE RUDDER STOCK BOTTOM PINTLE RUDDER STOCK BOTTOM PINTLE FP FP FP FP 7 15 06 08 PS | sa | Ps | se | | ps sa | Ps | $B 08 | 0.15 | 185) | 005 | [005 Tai | 05 0.05 05 075 075 AF AP. AP. AP REVIEW BY, INSPECTED BY, VERIFIED BY, at conTROL “OWNER SURVEYOR55 a VESSEL ‘TBROYALI P aa anaes nt PS®=CTON rewonenacr [ut __- STARDOARD& PORT SDE Ls ts a = x = : vill B = dee ae REVIEW BY, INSPECTED BY, VERIFIED BY, _ rf ; PRC ICER QUALITY CONTROL OWNER SURVEYORBB PANC/ SAVMADERA SHPYARD PT. PANCARAN SAMUDERA SHIPYARD. BLASTING AND PAINTING INSPECTION REPORT Praga None [TEROVACT apt Bae ea [Component lidenit. No. + [Project No_ Suse Popuraton Cana [V] asin. (leowiasoounc __(—Juvonoverme Seana eee aoe Ren ed oer eres — ne ATER TO TCORPCETED ran a sae a Era Serres |catach Press -0 Fim ) \cstacn Pres -© - Fim) |caach Press -O- [Conpieton af eang [baie OBO Hine co 00 WTA PAINTING Tacoat Bad Coat Bid Goat [Pant Manutackcer JOTUN PANT, [Type of Paint JOTAMASTIC BO AL [eaton No. (A) ® 2400070-1 a [Type of Tanner JOTUN THINNER NO 17 [batch No. 2375760-1 [DP C/Air Temp CRT 25 7% [Surface Temp © [start Date Tine Toea021 0.00 WiTA [WeT/ DFT Mierane 7508 inspected by (GG Paint Rep And Owner Rep [Remarks HT i to cert hat the above tome have been inspected and accepted by the Paint Representatves < [couaNY ine PANT REPRESENTATIVE | — OWNER REPRESENTATVE sionsvuRe Ae q [la Nan ROSEN TRA AIDENUARYS are| PANCS SAWADERA SHPYARD PT. PANCARAN SAMUDERA SHIPYARD. BLASTING AND PAINTING INSPECTION REPORT [Project Name [TB ROYAL T Report No |Component [Ress Date jort02021 ident. No.2 Project No ‘Surface Preparation /Caning (rower roouns [_JvoRe serine [Sencerd af Oeaning [sa20 Types of Abrasive [Sica Sand [Press -O- Fim Mirometer10 [Ecemeter [Aves inopected HTOPSIDE (100%)/ COMPLETED. [Ares inspected Before o%. [test Prove |Atach Press -O- Fm ) [Bias Prat | Atach Pres -O- Fim) Blast Proe (tach Press -0 Fim ) \Compaton of Ceaniag [bate OPO [Tine oo 00 WTA PAINTING Ta Coot Bd Com BaGoet [Paint Menufactrer OTN PANT Type of Paint TOTANASTIC 80 AL [eaten No. (A) © ac0a7o-1 PSE Hye of Thinner OTUNTHIN NER NOW Bach No. Baar 8A [DP OY Ar Temp IRF 2C 5c 7% [Surace Temp © a c Star Date Tmo TorazO7 DaOoWiTA [WET (OFT Micone 7500 inspected "QC Paint Rep And Owner Rep [Remarks = |Thisic to cetty thatthe above tems have been inspected and accepted by the Paint Reprocontatves Sao SIRS FANT REPRESENTA | ORR PREETI scnarune \ fe li rae mainte auiaa ARATE Se4 PT. PANCARAN SAMUDERA SHIPYARD => BLASTING AND PAINTING INSPECTION REPORT PANCARAN BANSABON Piet Naine [TE ROVALT Repaie aa [Component [ident. No.3 [Project No_ Saree Pepeten Channa [VL uanpeuanng | |pawsnzoounc amie eo Figs Araine Saco Pee Or come este aNSE RATER [00m TCOMPLETTED [Esmee fess ae Be me [seat faerie Baars [rasrPress-o-ren) (aman ess-0-Fim) a canon atc paar TROON PAINTING oo Rida doo Eas Pantenaeirer 7 ToTON PANT ine Pare 7 SHREGUAROES Fat earn 7 aa Bones Fipe ome 7 STON TERT Z eae 3 BISReT or car Ton cram wee | ae Z [Stoo Ten +e 7 toe Tie wae | omar | [wer OFT Ree oo Z Inset SS Pat op And Gora Re eran [rs sto cory athe above tems have been nspacted and scceptedby the Pant Represertaves \ [COMPAR \ press PAINT REPRESENTATIVE ‘GUNER REPRESENTATIVE pn ae ia [bare= >= PANCARAN BAVCERA SHPvARS, PT. PANCARAN SAMUDERA SHIPYARD. BLASTING AND PAINTING INSPECTION REPORT [Project Name [TS ROYAL 7 [Report No [PS5)2000_ as saat [Compare (ident. No. & [Project No micrecueioene | (Cleowmreaus —_[—Daraaayere ae eee Se ee eam pe pee ee on aa cole Pata e msi Petia) oda, ee mae PARTS aa ae ce Fase ee 7 Date 7 ; aa aR 7 ea Sane a J aan aa waaNR fae Fe E a ae Ions eee eee es eee sain - a RE SERE —| — SeRRERRATE aie \ om Tut — ae ko airy [bareB PT. PANCARAN SAMUDERA SHIPYARD = BLASTING AND PAINTING INSPECTION REPORT PANCARAN TORT rT — = ee acount [ident No 5 Project No Sete Peper eu CTeowmrooue —__(_Lanpaoerene a oh Seige oy nose Piociaren oneoanterres pee ee — pe — ae nate eee es pacrone [Completion of Cleaning (Date | 13/10/2021 [Time 10.00 WiTA, FaNTNG = ees oe Parmar! 7 ; a fora errant Re ED aes sae a 7 a HET ane ant Seemann ee Sorts I I = Sete [ae 7 TS [ER = 7 7 a = L QE Pani Rap dwar Rep — ieee Seats eee Laas eens [COMPANY PIPES PANT RAIRESENTATVE ‘OWNER REPRESENTATNE satin { Hat hae ee a ccohanaers ReB= PANICARAN SAMUDERA SHIPSARD BLASTING & PAINTING PROGRES TB ROYAL 1 1 Flatboron andcost2 OFT checkad ee 4 Ranta janie‘starbowd side 6 Piso Mar Poros Starboadside 17 Overview ater completed pint application BTU ROE ELIA CI TBT-Free Selfpolishing Ua aa to this ship is compliant with IMO’s AFS Convention* } al [mB ‘Supplied to: PT. PANCARAN SAMUDERA TRANSPORT TB. ROYAL 1 ly 13 OCTOBER, 2021‘his is to certify that Date of issue 13 October, 2024 “TB. ROYAL 1” was coated on the underwater area with TBT-free Self-Polishing Anti Fouling Self- Polishing system In compliance with the IMO Antifouling Systems Convention of 2001 (AFS/CONF/26) This certify is limited to the area which the antifouling system appied at dry docking at PT. Pancaran Samudera Shipyard, October 2021 The product is manufactured by Jotun Coatings and contains the following active ingredients SeaForce | Shield, D Red Dicopper Oxide (CAS Number 1317-39-1) Zineb (CAS Number 12122-67-7) Safeguard Universal ES, Plum (2.comp. primer) was applied to seal off any possibleexisting TBT-antifouling PAIGTUNNKDO! Gia IDONESIA ARIFIN TSS Support — Marine Coatings Indonesia Jotun Coatings This certificate does not replace the "Cerificate of Compliance" issued by the proper authorityQ ; BIRO KLASIFIKASI INDONESIA SERTIFIKAT PERSETUJUAN TIPE 1964 Type Approval Certificate No. 00089.20.7P01168 No. Persetujuan =: 00363TA20 2a of opal F Tanggel Perselujuan 17 Juli 2020 uf Dae of iprval Dengan ini dinyatakan bahwa produk dibawan ini telah memenuhi dan disetujul berdasarkan persyaratan dari Peraturan dan/atau Standard yang tercantum dibawah ini This 81 cer tha he following products has Been complied and apprened in accordance with requirements ofthe Ruler and/or Standard listed below Produk + Antifouling Systems Product Pembuat : PT. JOTUN INDONESIA, Monacrwee Kawasan Industri MM2100 BLOK KK-1, Cikarang Barat, Bekasi 17820, Indonesia Tipe Produk AFORCE SHIELD Tipe Design Standard persetujuan + Rules for Approval of Manufacturers and Service Suppliers (Pt.1, Vol. XI) ‘Approval standards Guidance for The Approval and Type Approval of Materials and Equipment for Marine Use (Part 4, Vol. W) IMO - International Convention on the Control of Harmful Anti-fouling System on Ships, Sertifikat ini berlaku hingga tanggal yang ditetapkan di bawah dengan syarat jika terdapat perubahan atau modifikasi pada produk harus segera diberitahukan ke BK{ This certificate remains wad il the date set belo provided that i there are ary aeration or macarons tthe approved prc. BKT shalt he nai ines Sertifikat ini berlaku sampai dengan :16 Juli 2025 This cerficae ts valid wil Jakarta 21 September 2020 ‘ha Peg Sone tn ps pce mee pron a es rin mh en ms ph rw Sn ret 214393PT. JOTUN INDONESIA No. Sentfkat Persetujuan :00069.20.7PO1108 a of Appronal Cerificate Lembar Pengukuhan Endorsement Sheet Sereda lh Surveyor 3K Pemeriksaan periodik (16 Juli 2022 sfd 16 Juli 2023) | Tenge! Perloicl surveillance (16 uy 2022 unl 16 uy 2023) | we No. Laporan Report no. Surveyor: CCatatan:-Sertifkat akan ditangguhkan secara otomatis jika tidak dikukubkan dalam rentang waktu yang telah citetapkan diatas. Note Theorie wil be aroma suspended ot endorsed ili te pecfied ime peri boreLampiran 1 Annex to Sertifikat Persetujuan Tipe Type Approval Certificate 1964 No, Sertikat - 00089.20.TPO1168, ‘No. Persetujian : 00363TA20 Neoeneea seeoaine. Destripsi Produk af Pri Besoin Seaforce Shields atin Fee self polshing,hydroysirg antioulng paint with active contents as mention below Cuprous Oxide ‘GAS No. 1317-361 Zine CAS No. 12122-67-7 ‘The product avatable in various colours. Kondisi Persetujuan {Conaton or Approve! 1. This approval is solely connected to the contol of harmful of Anti Fouling System as required by approval standard ‘applied. The approval is not includes any evaluation of corrosion protective perfcrmance, toxldly, contamination, polluton, or fire technical properties, 2. Considerations to be paid to the manufacturing recommendation concerning coating apptcation. 3. Individual product certfcation is not required. Dokumentast Persetujuan ‘Acgroal Decmanaton 41, BKI Assessment Report No. 01168-TP/C 1/2020 2) Technical Data Sheet and Material Ssfety Data Sheet for Seaforce Shield 3 Type approval teat report no. LT-10-20-0453 conducted by Unit Laboratorium Jase Penguian, Kalibrasi, dan Sertifikasi ~ Institut Pertanian Bogor recognized by BK! Penandsan Produk Wag of Pret ‘The folowing tems are 1o be cleerly marked on the paint coniainer labels or other suitable places. Product name . ‘Manufacturer's name or trace mark Manufacturer's production address ‘Type of Anti-Fouling System ‘Storage instruction Production date Batch number [BRIS approval number = 00363TA20 Pemeriksaan periodik For retention of the approval, a BKI Surveyor shall conduct perocical surveillance to vert that approved quailty system, etc ‘of the manufacturing works are maintained satisfactorly “The main scope of the periosécal survelionce wil nocmally include \Verifeaton of the manufacturer's production and quality system with rogard to ensure continued consistent production cof the Type Approved products atthe manufacturer's premises, Review of the approval documentation and that ths is sill sed as basis for the production ~ Review of possible changes tothe properties of the product = Verifcation ofthe product marking Fozsasa01eRes pases 214394