Form PMS

Issue Date: 01.09.05

PMS WORKS CARRIED OUT SINCE Issue No: 02
Rev. Date: ---
MAGNUS CARRIERS LAST REPORTING Rev. No: 00
CORPORATION Page: 1/1

Description of works carried out as per PMS Date carried out Form

Master: Ship’s C.Enineer:

Stamp

X
Name & Signature. Date :. Name & Signature.

This form has to be the send as a cover of the PMS reporting (every 2 months)
and all supporting documents/forms for the works carried out.