Pemeriksaan Kapal
Direktorat Jenderal Perhubungan Laut
Pangkalan PLP Kelas II Tg Perak
Name Ship
*
Name Ship
Name Agent
Agent Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number Agent
-
Area Code
Phone Number
Company
Date examination
*
-
Month
-
Day
Year
Date
Location
*
Area/coordinate
Initial Problem
*
Over draft
Safety equipment
Waste management
Other
Advance analysis
*
Verified!
Geolocation
Signature Examinee
Signature examinator
Submit
Should be Empty: