O’zbekiston avtomobil va daryo transporti agentligiga

O’zbekiston avtomobil va daryo

transporti agentligiga

ARIZA – ANKYeTA

Kema to‘g‘risida ma’lumotlar:

1. Kema nomi: _________________________________________________________

2. Kemaning oldingi nomi, oldingi ro‘yxatga olgan joy va u bekor qilingan sana (agar ular mavjud bo‘lsa): ________________________________________________

_____________________________________________________________________

3. Kema joylashgan manzil _____________________________________________

4. Chaqiruv signali (aralash suzuvchi(daryo-dengiz) kemalar uchun) _____________

5. Suzishga yaroqli to‘g‘risidagi guvohnoma: _______________________________

(qachon, kim tomonidan berilgan, №)

_____________________________________________________________________

6. Turi va vazifasi: ___________________________________________________

7. Kema klassi: _______________________________________________________

8. Loyiha №: ______________ qurilgan yili va joyi ______________________

9. Qobiq materiali: ___________________________________________________

10. Bosh dvigatel ( turi, soni, umumiy quvvati): __________________________

_____________________________________________________________________

11. Kemaning gabarit o‘lchamlari: uzunligi ________m., eni _______m., to‘la yuk bilan suvga botishi _________m., bo‘sh holda suvga botishi ________m., bo‘sh holda suvga botishidan qurilmalari bilan eng katta balandligi ________m.. Belgilangan yuk ko‘tarish qobiliyati:_________t., yo‘lovchi sig‘imi __________kishi.

Kema egasi to‘g‘risida ma’lumotlar:

1. Korxona nomi ______________________________________________________

_____________________________________________________________________

2. Joylashgan manzili _________________________________________________

_____________________________________________________________________

3. Pochta manzili ______________________________________________________

_____________________________________________________________________

4. Telefon, faks (teleks, teletayp, e-mail) ________________________________

_____________________________________________________________________

5. Korxonaning davlat ro‘yxatiga olinganligi to‘g‘risidagi guvohnoma (pasport): seriya, № _________________

berilgan sanasi: ____________ kim tomondan berilgan: ____________________

6. INN: ______________________________________________________________

7. Mulkchilik shakli: _________________________________________________

8. Kemani ro‘yxatga olish uchun asos ______________________________________

(shartnoma turi, raqami, sanasi)

9. Kema mulk huquqi, cheklash ____________________________________________

_____________________________________________________________________

(shartnoma yoki hujjatning turi, sanasi)

10. Korxona (tashkilot) rahbari _________________ ____________________

(imzo) (F.I.Sh.)

M.O’.
20____y. «_____» ___________