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Name of Ship: Survey Report No. Full Term ILL Certificate No.

Date: Place: Name and signature of Surveyor:

CHECK LIST FOR ANNUAL AND RENEWAL SURVEYSOF INTERNATIONAL LOAD LINE CERTIFICATE

This form applies for vessels holding an ILL Certificate(This form is not to be used for Load Line Surveys on Mobile Offshore Units)

NATIONAL SHIPPING ADJUSTER, INC.

Survey Items Condition (1) Action (2) Comments

(1) Y = Survey item considered in order; N = not in order; NA = not applicable.(2) If the item was considered not in order use: R = Recommendation given. IR = item repaired/rectified

ANNUAL SURVEY: (items 1 to 9.2)

Recommendations are to be given by thesurveyor, if applicable documentation is notavailable onboard.

Note that stability information is required to beonboard also for "existing ship" (ICLL-1930).

Alterations/removals/new installationsconcerning equipment and fittings covered byitems 3.1 to 8.1 of this check list shall beentered in record/report onboard and signedby the surveyor.

Check: position of the mark - correct lettering.

1. REVIEW OF DOCUMENTATION INMASTER´S OFFICE.Is the following documentation available onboard?

1.1 Stability information according to Reg. 10.2(ICLL-1966).

Approved by:

Dated:

1.2 Are there changes affecting the freeboardor the closing appliances?

2. FREEBOARD MARKS

2.1 The freeboard marks have been measuredand found to be in accordance with theLoad Line Certificate.

Dated:

3. MECHANICALLY OPERATED STEELHATCHCOVERS

Are the following items checked and foundin efficient condition?

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Survey Items Condition (1) Action (2) Comments

3.1 Gaskets, gasket lips, compression barsand drainage channels.

3.2 Clamping devices, cleatings and retainingbars.

3.3 Stoppers, guide rails, track wheels andchain or rope pulleys.

3.4 Hatchcovers with respect to corrosion,cracks or deformation.

3.5 Hatchcoamings with respect to corrosion,cracks or deformation to plating and supportingmembers connected to the deck.

3.6 Repairwork on hatchcovers andhatchcoamings.

3.7 Tightness test of hatchcovers (if deemednecessary).

Hose test: _______________________

Chalk test: _______________________

Other test: _______________________

Hold nos: _______________________

4. OTHER CLOSING APPLIANCES

Are the following items checked and found inefficient condition?

4.1 Superstructures, deckhouses andcompanionways with their bulkheads.

4.2 Closing appliances of doors and small hatchesetc. in superstructures and decks.

4.3 Engine and/or boilercasings with their doors,sills, skylights and fastenings.

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Check: non-return valves in drainage channels,that packing material is not perished or torn.

Check that retaining bars and compressionbars are not affected by excessive wastage.Check that cleatings ensure compression whencovers are seated (special attention to crossjoints).

Check maintenance.

Check of residual thickness of pontoons orcovers, plating and stiffening members, asdeemed necessary by the surveyor.

Check condition of coamings with stiffenersand connection to deck.

Tightness test: If the surveyor deems itnecessary to check the tightness devicesmore thoroughly than by visual inspection. Ifrepairs etc. have been carried out.

Check condition of bulkheads insuperstructures, deckhouses, companionwaysand casings with respect to corrosion, cracksand buckles.

Check condition of clamping devices, hinges,packings and sills. Hose test if deemednecessary.

Check condition of clamping devices, hinges,packings and sills. Hose test if deemednecessary.

Survey Items Condition (1) Action (2) Comments

4.4 Ventilators with closing appliances.

4.5 Airpipes with closing appliances.

4.6 Side scuttles below the freeboard deck and inenclosed superstructures, windows/sidescuttles in deckhouses.

4.7 Deadlights.

5. SIDE/STERN/BOW PORTS

5.1 Ports including gaskets and their closingappliances surveyed.

6. PROTECTION OF CREW

6.1 Bulwarks, guardrails, gangways, lifelines andthe protection and access to crew´s quarters.

6.2 Freeing ports and shutters.

7. SEA - AND SANITARY VALVES

7.1 External inspection of valves.

7.2 Operation of remotely operated side valves.

8. TIMBER FREEBOARD

8.1 Supplementary fittings.

9. ENDORSEMENT OF CERTIFICATE

9.1 International Load Line Certificate,

dated: _______________________________

and valid until ________________________

has been properly endorsed.

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Check: Condition of coamings with stays/supports especially connection to the deck.Weathertightness of closing appliances.

Check condition of pipe and connection todeck. Weathertightness of closingappliances.

Check weathertightness. Hinges and togglesto be easily movable.

Check weathertightness. Hinges and togglesto be easily movable. For supply vesselsdeadlights may be required at higherpositions.

Tightness test may be required if deemednecessary by the surveyor after visualinspection.

Check stanchions, stays, courses and lines.If underdeck passage, check ventilation,lighting and gas-, oil- and weathertightness.

Check rails, bars and shutters.

Check: external condition, tightness, holdingdown bolts.

To be tested in operation.

Check condition of permanent arrangements/appliances (e.g. eye plates and sockets foruprights). Lashings not required to be onboardwhen timber deck-cargo is not carried.

In case of deficiencies the surveyor should,as far as possible, request repairs and/orreplacement before the vessel leaves port.The certificate should only be endorsed ifminor recommendations are issued.

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Survey Items Condition (1) Action (2) Comments

9.2 Short term Load Line Certificate has beenissued.

Valid until: ____________________________

RENEWAL SURVEY: (items 10 to 18.2)(Applies to vessels holding an ILL Certificate and alsofor vessels surveyed according to national regulations.This form is not to be used for Load Line surveys onmobile offshore units).

10. REVIEW OF DOCUMENTATION INMASTER´s OFFICE.

Is the following documentation availableonboard?

10.1 Stability information according to Reg. 10.2(ICLL-1966).

Approved by: _________________________

Dated: ______________________________

10.2 "Record of Conditions of Assignment".

Dated: _______________________________

10.3 Other initial Load Line survey form.

Form No.: ____________________________

Dated: ______________________________

10.4 Are there changes affecting items 10.2 or 10.3above?

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Recommendations are not to be given by thesurveyor (items 10.1 to 10.4).

If applicable documentation is not availableonboard, NASHA surveyor to take thenecessary action.

Note that stability information is required to beonboard also for "existing ship".

Forms completed by other recognizedorganizations.

For alterations influencing the freeboard, thesurveyor shall fill in new form of "Record ofConditions of Assignment".

Alterations/removals/new installationsconcerning equipment and fittings covered byitems 12.1 to 17.1 of this check list shall beentered in record/report onboard and signedby the surveyor.

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11. FREEBOARD MARKS

11.1 The freeboard marks have been measuredand found to be in accordance with the LoadLine Certificate

Dated: ______________________________

12. MECHANICALLY OPERATED STEELHATCHCOVERS

Are the following items checked and found inefficient condition?

12.1 Gasket, gasket lips, compression bars anddrainage channels.

12.2 Clamping devices, cleatings and retainingbars.

12.3 Stoppers, guide rails, track wheels and chainor rope pulleys.

12.4 Hatchcovers with respect to corrosion, cracksor deformation?

12.5 Hatchcoamings with respect to corrosion,cracks or deformation to plating andsupporting members connected to the deck?

12.6 Repairwork on hatchcovers andhatchcoamings.

12.7 Tightness test of all hatchcovers.

Check position of the mark by measurements.

Check: Non-return valves in drainage channels,that packing material is not perished or torn.

Check that retaining bars and compressionbars are not affected by excessive wastage.Check that cleatings ensure compression whencovers are seated (special attention to crossjoints).

Check maintenance.

Check of residual thickness of pontoons orcovers, plating and stiffening members, asdeemed necessary by the surveyor.

Check condition of coam ings with stiffenersand connection to deck.

Normally all hatchcovers are required to behose tested. However, equivalent testingmethods may be accepted, e.g.

Air test on combination carriers, or

Ultrasonic test by special equipment.

Recommendation is to be given by surveyor forhatches not tested. Guidance: Nozzlediameter: M inimum 12mm. W ater pressure:Sufficient for a free height of water with streamdirected upwards of m in. 10m . Distance:Max. 1.5m .

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Survey Items Condition (1) Action (2) Comments

Survey Items Condition (1) Action (2) Comments

12.8 Testing of all hatch covers in operation.

13. OTHER CLOSING APPLIANCES.

Are the following items checked and found inefficient condition?

13.1 Superstructures, deckhouses andcompanionways with their bulkheads.

13.2 Closing appliances of doors and smallhatches, etc. in superstructures and decks.

13.3 Engine- and/or boilercasings with their doors,sills, skylights and fastenings.

13.4 Ventilators with closing appliances.

13.5 Airpipes with closing appliances.

13.6 Side scuttles below the freeboard deck andenclosed superstructures, windows/sidescuttles in deckhouses.

13.7 Deadlights.

14. SIDE/STERN/BOW PORTS

14.1 Ports including gaskets and closingappliances.

15. PROTECTION OF CREW

15.1 Bulwarks, guardrails, gangways, lifelines andprotection and access to crew`s quarters.

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Check stowage, securing (open condition),proper fit, locking and efficiency of sealings(closed condition).

Check condition of bulkheads insuperstructures, deckhouses, companionwaysand casings with respect to corrosion cracksand buckles.

Check condition of clamping devices, hinges,packings and sills. Hose test if deemednecessary.

Check condition of clamping devices, hinges,packings and sills. Hose test if deemednecessary.

Check condition of coamings with stays/supports and especially connection to thedeck.Weathertightness of closing appliances.

Check condition of pipe and connection todeck.Weathertightness of closing appliances.

Check weathertightness.  Hinges and togglesto be easily movable.

Check weathertightness. Hinges and togglesto be easily movable. For supply vesselsdeadlights may be required at higher positions.

Tightness test: Hose test is required.

Check stanchions, stays, courses and lines.If underdeck passage, check ventilation,lighting and gas-, oil- and weathertightness.

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Survey Items Condition (1) Action (2) Comments

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15.2 Freeing ports and shutters.

16. SEA - AND SANITARY VALVES

16.1 External inspection of valves.

16.2 Operation of remotely operated side valves.

16.3 Scuppers and sanitary discharges.

16.4 Sea inlets and outlets including valves.

17. TIMBER FREEBOARD

17.1 Supplementary fittings.

18. INTERIM ILL CERTIFICATE

18.1 Interim Load Line Certificate.

Valid until: ___________________________

Extended until: _______________________

18.2 Has endorsement been made on "Record ofConditions of Assignment"?

Check rails, bars and shutters.

Check: External condition, tightness.

To be tested in operation.

Opening up of valves.

Opening up of valves.

Check condition of permanent arrangements/appliances (e.g. eye plates and sockets foruprights). Lashings not required to be onboardwhen timber deck-cargo is not carried.

All non-compliances not considered as minorrecommendations should be carried out beforeissuing the interim certificate.

New full term certificate will not be issued untilall recommendtaions have been deleted andSpecial Periodical Survey, Hull, has beencarried out and updated.

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RECOMMENDATIONS/OBSERVATIONS Survey Report No. ___________________________________

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Surveyor: ___________________________________ Place of Survey:

NATIONAL SHIPPING ADJUSTER, INC. Date of Survey: _________________________