m/v ………………………………………………………… date ………………..

No.	Item	Quantity

……………………….

Master

Superintendent's remarks:

Note: To be completed when necessary and filed in both office's file and ship's file.

To retain for 5 years.

Issue date: 03.11.2003/Rev 00 PBO-TD02-F08 Page: 1/1

SPARES SENT ASHORE FOR REPAIR

QSMS PBO-TD02-F08 Rev. No. 00

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