<p> SMALL VESSEL P&I VESSEL CONDITION SURVEY REPORT</p><p>M.V...... </p><p>[Photograph]</p><p>Year Built Name Of Surveyor G.T. Company Class Place Of Survey Owners Date Of Survey Managers Date Of Report</p><p>Vessel is in satisfactory / unsatisfactory condition (DELETE AS APPROPRIATE)</p><p>V1/Oct2014</p><p>1 Summary / Remarks / Conclusions</p><p>(Based on surveyor’s overall impression of the vessel, the surveyor is requested to rate the vessel as per following rating scale)</p><p>RATING SCALE 5 Very good Satisfactory in all respects. 4 Good Some minor issues to address. 3 Fair Acceptable subject to remedial measures. 2 Poor Serious issues to address. 1 Very poor Unacceptable in present condition</p><p>Rating 1 to 5</p><p>1. Shipboard Management</p><p>2. Shipboard Safety and Environmental Awareness </p><p>3. Fire Safety</p><p>4 Life Saving Appliances</p><p>5. Pollution Prevention</p><p>6. Navigation</p><p>7. Structural Condition</p><p>8. Machinery</p><p>9 Cargo Worthiness</p><p>10. Maintenance and Housekeeping</p><p>2 2 Narrative overview of vessel’s condition (Please describe subjectively under following headings – use as much space as necessary)</p><p>2.1 Certificate / Documentation Status: </p><p>2.2 Hull and Deck Structure, date of last dry dock:</p><p>2.3 Ballast Tanks: </p><p>2.4 Cargo Worthiness:</p><p>2.5 Cargo Gear:</p><p>2.6 Navigation and Communications: </p><p>2.7 Shipboard Management and Manning: </p><p>2.8 Pollution Prevention:</p><p>2.9 Fire Prevention, Life Saving and Emergency Response:</p><p>2.10 Machinery:</p><p>Page 3 3 DEFECT LIST (Note that format of defect list is not to be altered other than for adding additional rows if required)</p><p>Vessel Name IMO No. Port Date of Survey</p><p>Notes: 1. Leave one copy onboard with the Master. 2. A copy of this form is to be submitted electronically to the Club in “Word” format 3. Add more rows as required. 4. For follow-up surveys and rectification reports the status of all defects, recommendations and outstanding tests & requirements is to be noted as either COMPLETED, IN PROGRESS or OUTSTANDING in the “REMEDIAL ACTION REQUIRED” column immediately after the surveyor’s text. If new defects are noted during the follow-up survey then they should be added to the List of Defects.</p><p>NO DEFECT REMEDIAL ACTION REQUIRED For Lodestar use .</p><p>5. All outstanding tests and inspections are to be listed below not as defects</p><p>4 NO. OUTSTANDING TESTS / INSPECTIONS UPON COMPLETION OF SURVEY 1 2</p><p>Page 5 4 Selected Photographs</p><p>6</p>