MA-1025 Vessel Data and Capital Cost

							OMB No. 2133-0514
							Expiration Date: 10/31/2013
Maritime Administration
VESSEL DATA AND CAPITAL COSTS
Vessel Name:
Vessel DWT:			Official No.:			Date Built:
Date Purchased: (if applicable)				Date Rebuilt: (if applicable)
Canal Tonnage: Suez Canal Panama Canal
		Net		Gross		Net		Gross
Vessel Dimensions: Length Breadth
Normal Operating Speed: Loaded In Ballast
Daily Fuel Consumption: At Sea* In Port
Fuel Type			MT or GAL			Standing		Pumping**
Capitalized Vessel Costs
Capital Item		Amount		Date of Capitalization			Rate of Interest On
							Associated Debt***
I hereby certify that I have carefully examined the foregoing form and to the best of my knowledge and
belief the information contained herein is true, accurate and complete.
Signature			Title				Date
* At normal operating speed
**If applicable
***List only debt secured by a mortgage on the vessel. If serial bonds, list the original principle amount and
interest rate for each series. If the interest rate is variable, list formula, I.e., LIBOR +1%.
FORM MA-1025 (Rev. 5-2013)