Pre-Assessment Questionnaire for



For a quick response, this questionnaire may be faxed or e-mailed directly to:Fax: 1-281-877-6001 (Americas)Email: msc-amer@Fax: 30-210-9403610 (Europe)Email: msc-eur@Fax: 65-6275-0258(Pacific)Email: msc-pac@Fax: 86-21-6322-9649 (Greater China)Email: msc-china@1.General InformationPHYSICAL ADDRESS. FORMTEXT ????? FORMTEXT ?????Company NameCompany IMO Number FORMTEXT ?????Address FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????CityState or CountryPostal Code FORMTEXT ????? FORMTEXT ?????Contact PersonTitle FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????PhoneFaxEmailBILLING/INVOICING ADDRESS? SAME AS PHYSICAL FORMTEXT ?????Address FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????CityState or CountryPostal Code FORMTEXT ????? FORMTEXT ?????Contact PersonTitle FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????PhoneFaxEmailCORRESPONDENCE ADDRESS? SAME AS PHYSICAL FORMTEXT ?????Address FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????CityState or CountryPostal Code FORMTEXT ????? FORMTEXT ?????Contact PersonTitle FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????PhoneFaxEmail2.Fleet Breakdown by Vessel Type and “Sister Vessels”: Please indicate total number of vessels per vessel type and the number of vessels that are similar in design. This information will assist ABS in estimating the duration of plan reviews & assessments, preparing an accurate estimate and identifying any special requirements for your company’s fleet. A fee reduction may be offered to the second and subsequent sister vessel of each vessel type.Sister Vessels (vessels similar in design)Vessel TypeTotal No.Type 1.Type 2.Type 3.Type 4.Type 5.Type 6.Type 7.Type 8.Type 9.Type 10.Passenger Vessels * FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ????Cargo Vessels ** FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ????OSV’s / Towing Vessels FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ????Mobile Offshore Drilling Units FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ???? FORMTEXT ????* Including Passenger High Speed Craft**Including Oil Tankers, Chemical Tankers, Gas Tankers, Bulk Carriers, Cargo High Speed Craft, Container, General & Other Cargo Vessels3. Fleet Breakdown by Flag: (please indicate number of vessels by flag). This will assist ABS in preparing an accurate estimate for your company’s fleet, based upon any additional flag requirements.Flag of Registry FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????No. of vessels FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4. Fleet Breakdown by Class Society:SocietyABSBVCCSDNVGLKRLRNKRINARSOthers FORMTEXT ?????No. of vessels FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5.Planning Information:Projected Date:Ship Security Plan Review: FORMTEXT ?????Pre-assessment (optional): FORMTEXT ?????Certification Assessment: FORMTEXT ?????6.Fleet Vessel Information: The information provided will assist ABS in estimating the fees associated with SSP reviews and shipboard verifications, as well as identifying any special requirements that may apply. Please complete table below or attach separate sheet(s).Vessel NameVessel TypeVessel IMO No.Class No. FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????7. CERTIFICATION TO ABS GUIDE FOR SHIP SECURITYABS also offers certification to the ABS Guide for Ship Security in conjunction with ISPS Code certification. The Ship Security Guide is designed to meet or exceed the requirements of the ISPS Code (Parts A & B). Upon certification, ABS issues SEC Notation to ABS classed vessel to indicate that the vessel complies with the requirements of Part A & B, and the ABS Guide for Ship Security: In addition to mandatory ISPS Code Certification (Part A & relevant sections of Part B), does your Company want certification to the ABS Guide for Ship Security?Yes FORMCHECKBOX FORMCHECKBOX ?No FORMCHECKBOX FORMCHECKBOX ?8.Additional Information or comments (if any): FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????ABS Use OnlyReceived By: FORMTEXT ?????Reviewed By: FORMTEXT ????? ................
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