Head office : Jl. Slamet Riyadi No.09C RT.43 Loktuan Bontang Kalimantan Timur

RECEIPT/DELIVERYContainer Inspection Cheklist

NAMA KAPAL : NO

BENDERA : TANGGAL

HATCH. NO : DRIVER

No. Kendaraan Deskripsi WaktuDikirim Diterima

Container InspectionNomor Container Nomor Segel

No InspectedKondisi Container

Baik Rusak Penyok Lobang Berkarat Tidak diketahui

1 Bagian Atas/Atap2 Bagian dalam3 Bagian Kanan4 Bagian kiri5 Dinding Depan6 Bagian Belakang7 Lantai8 Pintu/Kunci

Catatan *)

DIPERIKSA OLEH, DITERIMA MENGETAHUI,

KAPAL PBM EKSPEDISI SECURITY KNI

PT. PBM. ELSA JAYA

2

4

5 8

RECEIPT/DELIVERYContainer Inspection Cheklist

:

:

:

Waktu CatatanDiterima

Container Inspection

Catatan *)

MENGETAHUI,

SECURITY KNI KNI

1

3

6

7

TALLY SHEET/DELIVERY/RECEIPT

Name Of Vessel : Kind Of Cargo :Voy. No : Total :Loading Port : Commenced :Discharging Port : Finish :

NO DATE HOURS HATCH CONTAINER NO SEAL NO LOCATION FULLBay No. Row No. Tier No. 20"

TOTAL

Aknowledge by, PT. KNI Prepared By,PBM ELSA JAYA

TALLY SHEET/DELIVERY/RECEIPT

FULL NETTO40"

Prepared By,PBM ELSA JAYA

Nama Kapal :Bendera :Loading Port :Discharging Port :NO NOPOL QUANTITY

1 2 3 4 5

300300590580

1770

CONTAINER INSPECTION CHEKLIST

CONTAINER NUMBER

SEAL NUMBER

IMPORTER

SHIPPER/FACTORY

INSPECTION KONDISI PEMERIKSAANFront Wall Baik RusakBlocks and Vents are visibleno hollow sound heards when tapped with a toolLeft Sideno unsual repairs to structural beamsrepairs to inside wall are also visible on the outsideno hollow sound heards when tapped with a toolRight Sideno unsual repairs to structural beamsrepairs to inside wall are also visible on the outsideno hollow sound heards when tapped with a toolOutside undercarriagesupport beams are visible (use mirror to view underside)FloorAppears flatonly one floor height within containerCeeling/roofBlocks and Vents are visiblerepairs to inside wall are also visible on the outsideno hollow sound heards when tapped with a toolInside/outside doorsLocking mechanism is in good working conditionno loose bolts, plates or repairs

CONTAINER INSPECTION CONDUCTED BYNAME &DATE

SEAL INSPECTED & AFFIXED BY NAME &DATE

CONTAINER LOADED BYNAME &DATE

CONTAINER LOADING MONITORED BYNAME &DATE

CONTAINER INSPECTION CHEKLIST

KONDISI PEMERIKSAANPenyok Lobang Berkarat Tidak diketahui

SIGNATURE

SIGNATURE

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