Report No.: Name of Ship: Plans referred during Initial Survey:

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Report on the Surveys Concerning International Oil Pollution Prevention Certificate Part 7 Survey of installation for discharges from cargo spaces Initial/ Annual/ Intermediate/ Renewal/ Change of Flag Survey/ General Examination* Name of Ship: Plans referred during Initial Survey: 1 2 3 4 5 No Item Condition A. Documentation 1 Confirmation that subdivision and damage stability information in an approved form, where applicable, is on board 2 Where a stability instrument is fitted on board, Confirmation that: a Document of Approval (DOA) as required by MARPOL Annex I, Regulation 28(6) has been issued by/ on behalf of the Administration. b An approved operation manual for stability instrument including test conditions are available on board. 3 Where the Administration has waived the requirements of stability instrument (Regulation 28(6)), Confirmation that necessary waiver issued by the Administration is available on board and reflected in FORM B 4 Confirmation that the ship is allowed continued operation according to the phase-out scheme of MARPOL 90/04 Annex I reg.20 5 Confirmation that the approved Dedicated Clean Ballast Tank Operation Manual and/or the approved Operations and Equipment Manual for the Crude Oil washing Systems, as appropriate, is/are on board 6 Confirmation that, when appropriate, that a CAS Statement of Compliance together with the CAS Final Report are on board 7 Confirmation that, if applicable, a Ship to Ship (STS) operations Plan approved by the Administration has been provided 8 Confirmation that, if applicable, a Crude Oil Washing Operations and Equipment Manual has been provided Form No.: 4704 Part 7 (Rev.4) Page 1 of 8 * Delete as appropriate

9 Confirmation that the intact stability has been approved (applicable for oil tankers of 5000dwt and above delivered on/after 1 February 2002) 10 Confirmation that, for oil tankers of 5,000 tonnes deadweight and above, that arrangements are in place to provide prompt access to shore-based damage stability and residual structural strength computerized calculation programs 11 Verification whether any new equipment has been fitted and, if so, confirmation that it has been approved before installation and that any changes are reflected in the appropriate certificate 12 Confirmation that certificate for the type approval of the oil discharge monitoring equipment, is available on board (Note: When carrying bio-fuel blends containing 75percent or more of petroleum oil, oil discharge monitoring equipment (ODME) shall be type approved in accordance with MEPC.108(49) as amended by MEPC.240(65) and approved for the mixture being transported) 13 Confirmation that the approved Operating and Maintenance manual for the oil discharge monitoring and control system, is on board 14 Confirmation, for installations complying with resolution MEPC.108 (49), that the oil content meter has been calibrated by the manufacturer or a person authorized by the manufacturer and that a valid calibration certificate is available on board. 15 Confirmation that record of the various oil discharge monitoring equipment are in order 16 Confirmation that certificates for the type approval of oil/water interface detectors, are available on board 17 Confirmation that Oil Record Book Part II is provided and appropriate entries have been made. B. Equipment and arrangements 1 Confirmation that an approved stability instrument, if fitted on board as required by Regulation 28(6), has been checked for accuracy at regular intervals by the ship s staff by applying test loading conditions. 2 Confirmation of satisfactory external examination of the oil discharge monitoring and control system and its associated equipment and, if applicable, verifying that the instrument is properly sealed 3 Confirmation, as far as practicable, the satisfactory operation of the oil discharge monitoring and control system including the oil content meter and, where applicable, the automatic and manual means provided to stop the discharge of effluent and the starting interlock 4 Confirmation that indicators and recording devices are operable and that sufficient supply of consumables for the recorders are on board Form No.: 4704 Part 7 (Rev.4) Page 2 of 8 * Delete as appropriate

5 Confirmation of satisfactory testing, as far as practicable, of any audible or visual alarms fitted to the oil discharge monitoring and control system 6 Confirmation of satisfactory examination, as far as practicable, of the oil/water interface detectors 7 Confirmation that no cross-connections have been fitted between the cargo and segregated ballast systems 8 Where a portable spool piece is provided for the emergency discharge of segregated ballast by connecting the segregated ballast system to a cargo pump, confirmation that non-return valves are fitted on the segregated ballast connections and that the spool piece is mounted in a conspicuous position in the pump room with a permanent notice restricting its use 9 Confirmation by sighting that there has been no contamination with oil in the segregated ballast tanks 10 Confirmation by external examination that the crude oil washing piping, pumps, valves and deck mounted washing machines are free from any sign of leakage and that all anchoring devices for crude oil washing piping are intact and secure 11 Confirmation, in those cases where drive units are not integral with the tank cleaning machines, that the number of operational drive units as specified in the Manual are on board 12 Confirmation that, when fitted, steam heaters for water washing can be properly isolated during crude oil washing operations, either by double shut-off valves or clearly identifiable blanks 13 Confirmation that the prescribed means of communications between the deck watch keeper and the cargo control position is operational 14 Confirmation that an overpressure relief device (or other approved arrangement) is fitted to the pumps supplying the crude oil washing systems 15 Confirmation that flexible hoses for supply of oil to the washing machines on combination carriers, are of an approved type, are properly stored and are in good condition 16 Confirmation by checking, as far as practicable, that the crude oil washing machines are operable and, when the survey is carried out during crude oil washing operations, by observing the proper operation of the washing machines by means of the movement indicators and/or sound patterns or other approved methods 17 Confirmation by checking, as far as practicable, the effectiveness of the stripping system in appropriate cargo tanks by observing the monitoring equipment and by hand-dipping or other approved means 18 Confirmation that on those existing tankers operating with special ballast arrangements, the arrangements are as approved and are satisfactory Form No.: 4704 Part 7 (Rev.4) Page 3 of 8 * Delete as appropriate

19 Confirmation that the piping systems associated with the discharge of dirty ballast or oil-contaminated water including the part flow system, are satisfactory 20 Verification by testing the communication system between the observation and discharge control positions is satisfactory 21 Confirmation that the means of draining cargo pumps and cargo lines, including the stripping device and the connections for pumping to the slop or cargo tanks or ashore are satisfactory C. Additional items for Intermediate Survey and Renewal Survey 1 Examining the oil discharge monitoring and control system and the oil content meter for obvious defects, deterioration or damage, and checking the record of calibration of the meter when done in accordance with the manufacturer's operational and instruction manual 2 Confirming the satisfactory operation of the oil/water interface detectors 3 Examining the crude oil washing piping outside the cargo tanks. If upon examination there is any doubt as to its condition, the piping may be required to be pressure tested, gauged or both. Particular attention should be paid to any repairs such as welded doublers 4 Confirming the satisfactory operation of the isolation valves to steam heaters for washing water, when fitted 5 Examining at least two selected cargo tanks for verifying the continued effectiveness of the installed crude oil washing and stripping systems. If the tank cannot be gas-freed for the safe entry of the surveyor, an internal examination should not be conducted. In this case this examination may be conducted in conjunction with the internal examination of cargo tanks as part of the structural survey required for SAFCON intermediate survey 6 Examining the manual and/or remote operation of the individual tank valves (or other similar closing devices) to be kept closed at sea D. Additional items for Renewal Survey 1 Confirmation that an approved stability instrument, if fitted on board as required by Regulation 28(6), has been checked for accuracy by applying test load conditions in presence of the Surveyor. 2 Confirmation, if necessary by simulated test or equivalent, of the satisfactory operation of the oil discharge monitoring and control system and its associated equipment, including the oil/water interface detectors 3 Confirmation that the arrangements of pumps, pipes and valves are in accordance with the requirements for SBT systems and there are no cross-connections between the cargo and segregated ballast systems Form No.: 4704 Part 7 (Rev.4) Page 4 of 8 * Delete as appropriate

4 Confirmation that the arrangements of pumps, pipes and valves are in accordance with the Revised Specifications for Oil Tankers with Dedicated Clean Ballast Tanks 5 Confirmation that the crude oil washing system is in accordance with the requirements for such systems 6 Carrying out pressure testing of the crude oil washing system to at least the working pressure and confirming it is satisfactory 7 Examining the cargo tanks verifying the continued effectiveness of the installed crude oil washing and stripping systems 8 Examining internally, when fitted, the isolation valves for any steam heaters 9 Verifying, by internal tank inspection or by another alternative method acceptable to the Administration, the effectiveness of the crude oil washing system. If the tank cannot be gas-freed for the safe entry of the surveyor, an internal inspection should not be conducted. An acceptable alternative would be verification of arrival/departure ballast, verification of operation of COW machines, verification of effectiveness of stripping system. 10 Confirmation that there is no leakage from those ballast pipelines passing through cargo tanks and those cargo pipelines passing through ballast tanks 11 Confirmation that the pumping, piping and discharge arrangements are satisfactory 12 Confirmation that the means of draining cargo pumps and cargo lines, including the stripping device and the connections for pumping to the slop or cargo tanks or ashore are satisfactory 13 Confirmation that the arrangements for the part flow system, where fitted, are satisfactory 14 Confirmation that closing devices installed in the cargo transfer system and cargo piping as appropriate are satisfactory E. Additional items for Initial Survey 1 In respect of installation of stability instrument as required by MARPOL Annex I, Regulation 28(6), confirmation that:- a b Documents pertaining to approval of software, test conditions and user manuals are available on board. Installation testing of the stability instrument has been done and found to be satisfactory. c Document of Approval (DOA) has been issued by/ on behalf of the Administration. 2 Confirmation of satisfactory installation of the oil discharge monitoring and control system as per the approved plan/technical installation specification and in accordance Form No.: 4704 Part 7 (Rev.4) Page 5 of 8 * Delete as appropriate

with the manufacturer s equipment specification/ installation instructions. Operational outlets are located in the positions indicated on the drawing of the pumping and piping arrangement. The piping and probes are of a material resistant to fire, corrosion, and oil and are of adequate strength, properly jointed and supported 3 Confirmation that the arrangements of slop tanks or cargo tanks designated as slop tanks and associated piping systems are satisfactory 4 Confirmation that if installed in a hazardous area, the electrical components of the monitoring system meet the appropriate safety requirements laid down for these areas. Any bulkhead penetration between a hazardous and a non-hazardous area is of a design approved by the Administration. 5 Confirmation that each main component of the oil content monitoring system is fitted with a name-plate, properly identifying the component by assembly drawing number, type or model number and serial number, as appropriate 6 Confirmation that on-board functional test of the oil discharge monitoring and control system carried out satisfactorily. Verification of absence of leakage in the sample pumping and piping system, correct functioning of remote controlled sampling valves, system operation under correct flow conditions, correct functioning of alarms when a malfunction occurs external to the monitoring system, manual override control, automatic recording(print out) function 7 Verification that the overboard discharge control is able to stop the discharge of the effluent into the sea automatically by either closing all relevant overboard discharge valves or stopping all relevant pumps. The discharge control arrangement is fail-safe so that all effluent discharge is stopped when the monitoring system is not in operation, at alarm conditions, or when the monitoring system fails to function. In the event of power failure the processor is capable of retaining its memory in respect to computation of the total quantity of oil discharged, time and date. 8 Testing ballast pipelines that pass through cargo tanks and those cargo pipelines that pass through ballast tanks to ensure there is no cross contamination 9 Confirmation that the crude oil washing system is installed in accordance with the approved plans 10 Carrying out pressure testing of the crude oil washing system to 1.5 times the working pressure 11 Confirmation that, where there is a crude oil washing system, an inert gas system has been installed and tested in accordance with the requirements of SOLAS 12 Confirmation that closing devices installed in the cargo transfer system and cargo piping, as appropriate, are satisfactory 13 Confirmation that the subdivision and stability arrangements to prevent progressive flooding are satisfactory 14 Confirmation that the arrangements for cargo pump-room bottom protection (double bottom where required) are satisfactory Form No.: 4704 Part 7 (Rev.4) Page 6 of 8 * Delete as appropriate

15 Confirmation that the arrangements for the prevention of oil pollution in the event of collision or stranding are in accordance with the approved plans F. Additional requirements for ships operating in Polar Waters 1 Confirmation that the Polar Ship Certificate is available on board and valid 2 Confirmation that operation in polar waters have been taken into account, as appropriate, in the Oil Record Book Part II. 3 Confirmation that Polar Ship Certificate has been issued/ endorsed* based on satisfactory survey G. Additional requirements for ships operating in Polar Waters (Initial Survey) 1 Confirmation that the arrangements for the prevention of oil pollution in the event of collision or stranding are in accordance with the approved plans (Note: For category A and B ships other than oil tankers constructed on or after 1 January 2017, all cargo tanks constructed and utilized to carry oil shall be separated from the outer shell by a distance of not less than 0.76 m.) 2 Confirmation that the arrangements for the prevention of oil pollution in the event of collision or stranding are in accordance with the approved plans (Note: For category A and B oil tankers of less than 5,000 tonnes deadweight constructed on or after 1 January 2017, the entire cargo tank length shall be protected with:.1 double bottom tanks or spaces complying with the applicable requirements of regulation 19.6.1 of MARPOL Annex I; and.2 wing tanks or spaces arranged in accordance with regulation 19.3.1 of MARPOL Annex I and complying with the applicable requirements for distance referred to in regulation 19.6.2 of MARPOL Annex I.) 3 Confirmation that Polar Ship Certificate has been issued based on satisfactory survey This is to certify that the undersigned has examined the ship as reported herein, and has compared the arrangements and equipment on board with the Record of Construction and Equipment and found them to be in agreement. All the parts surveyed were found to be well maintained and in an efficient and good working condition. It has been verified that appropriate entries have been made in the Oil Record Book. It has been verified that the instruction manual for oily water separating equipment or filtering system for control of effluent from machinery spaces is available on board. It has been confirmed as far as practicable, that no unapproved modifications have been made to the ship and its equipment. Form No.: 4704 Part 7 (Rev.4) Page 7 of 8 * Delete as appropriate

After satisfactory completion of survey IOPP certificate issued/ endorsed as indicated below: IOPP certificate on board endorsed on:...(dd/mm/yyyy). Surveyor(s) to Indian Register of Shipping Port : Reviewer for Indian Register of Shipping Place : Form No.: 4704 Part 7 (Rev.4) Page 8 of 8 * Delete as appropriate