- Name of Ship
- Official Number
- Call Sign
- Port of Registry
- Name of Owner
- Register Number
- Date of Issue
- Issued by
- Signature and Stamp
Part I: Entries concerning four yearly examinations and annual examinations.
Part II: Contains entries concerning thorough annual examinations of cranes, winches and hoists. Accessory gear other than derricks is also included.
Part III: For entries concerning the thorough annual examination of gear exempted from annealing.
Part IV: For entries concerning the annealing of gear.
The last page contains some recommended factors of safety. e.g.
Chain/Wire = 5
Rope = 6
Derrick = 9