MARITIME AND PORT AUTHORITY OF SINGAPORE Shipping Division 460 Alexandra Road #21-00 PSA Building Singapore 119963 DID: (65) 6375 1932 Fax: (65) 6375 6231 Email:
[email protected]
This form will take approximately 10 minutes to fill in, provided you have the necessary supporting information ready.
INTERNATIONAL SAFETY MANAGEMENT (ISM) CODE DECLARATION OF COMPANY Under the ISM Code, a Company must be declared to the Administration. In accordance with Section 1.1.2 of IMO Resolution A. 741(18), the ISM code, "Company" means the Owner of a ship or any other organization or person such as the Manager, or the Bareboat Charter, who has assumed the responsibility, has agreed to take over all the duties and responsibility imposed by the Code, the undersigned affirms that: Name: Address:
Telephone no.:
Fax no.:
Email, if any:
is the owner of record of the following registered Ship(s): Ship Name
Official No.
IMO No.
In accordance with Section 3.1 of Assembly Resolution A. 741(18), if the entity who is responsible for the operation of the ship is other than above stated Owner, the Owner must report the full name and details of such entity to the Administration. If such is the case here, the undersigned affirms that: Name: Address :
Telephone no.:
Fax no.:
Email, if any :
is the "Company" responsible for all the requirements by the Code for registered Ship(s) listed above. ____________________ Date
1
____________________ Director of Owning Company1
The declaration in this form may be signed by the owner or by his appointed agent. Where the owner is a corporate body, the form may be signed by a Director or the Secretary of the corporate body. A copy of the Power of Attorney would have to be attached together with the Form if the declaration is signed under an appointed agent.