569 



Date: 



Signed 



(Signature of duly authorized official) 



Place 



Date 



(Seal or stamp of the Authority, as appropriate) 



Appendix III 

 Foi^n of Oil Record Booh 



OIL RECORD BOOK 



I— For Oil Tankers \}'\ 



Name of ship 



Total cargo carrying capacity of ship in cubic metres 



Voyage from (date) to (date) 



(a) Loading of oil cargo : 



1. Date and place of loading : 



2. Types of oil loaded : 



3. Identity of tank (s) loaded: 



4. Closing of applicable cargo tank valves and applicable line 



cut-off valves on completion of loading :[2] 

 The undersigned certifies that in addition to the above, all sea valves, 

 overboard discharge valves, cargo tank and pipeline connections and 

 interconnections, were secured on completion of loading oil cargo. 



Date of entry Officer in charge 



Master 



(b) Internal transfer of oil cargo during voyage: 



5. Date of internal transfer : 



6. Identity of tank (s) ^ 



i. From: 

 ii. To: 



7. Was (were) tank(s) in6(i) emptied? 



The undersigned certifies that in addition to the above, all sea valves, 

 overboard discharge valves, cargo tank and pipeline connections and 

 interconnections, were secured on completion of internal transfer of 

 oil cargo. 



Date of entry Officer in charge 



Master 



(c) Unloading of oil cargo: 



8. Date and place of unloading : 



9. Identity of tank (s) unloaded: 



1 Tills part should be completed for oil tanlters including combination carriers and 

 asphalt carriers, and those entries which are applicable shall be completed for ships 

 other than oil tankers which are constructed and utilized to carry oil in bulk of an 

 aggregate capacity of 200 cubic metres or above. 



^Apr>licable valves and similar devices are those referred to In regulations 20(2) (a) 

 (iiij, 23 and 24 of Annex I of the Convention. 



