FMS WAM

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DELIVERY/RE-DELIVERY STATEMENT

THIS IS TO CERTIFY THAT, the M/T :

Port of Registry :

SINGAPORE

Official number :

Gross Tons

was duly delivered/re-delivered by

to and accepted by

HONGLAM MARINE PTE LTD

at location

on the

at

Hrs local time.

It was agreed that at

Hrs local time, on the

The vessel had bought the following:

MARINE GAS OIL :

MARINE DIESEL OIL :

MARINE FUEL OIL 500 CST :

LUBRICATION OIL :

FRESH WATER :



MASTER

CHIEF ENGINEER

(NAME/SIGNATURE/STAMP)

(NAME/SIGNATURE/STAMP)



OWNER'S AGENT

CHARTERER'S AGENT

(NAME/SIGNATURE)

(NAME/SIGNATURE)



SURVEYOR (if any)*

(NAME/SIGNATURE/STAMP)

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