|Name:||Keel laying date:|
|Check the suitable box:||Full VDR SystemüS-VDR System|
|VDR/S-VDR Manufacturer and type:|
|VDR/S-VDR Serial Number:|
|Date of Installation:|
|Type of Capsule:|
|Type of Beacon:|
|Indicate any present or recent alarms displayed by the VDR/S-VDR|
|Indicate the last replacement date of the VDR/S-VDR internal back up batteries.|
|Indicate the expiration date of the beacon|
REPORT OF ANY DEFICIENCIES
|Provide a postal address where the Certificate of Compliance can be sent if the APT is successful.|
- Please make sure all navigational equipment is switched on 12 hours prior to the scheduled time for the APT.
- Failure to complete this form and report accurately may result in the APT having to be stopped until such time as any found deficiencies are corrected.