Panama Maritime Documentation Services, Inc.



Class ARSApplication Form for Statutory Surveys/CertificationsName: FORMTEXT ?????Date: FORMTEXT ?????(Person / Company name)(dd/mm/yyyy)Address: FORMTEXT ?????Phone: FORMTEXT ?????Signatue and StampFax: FORMTEXT ?????E-mail: FORMTEXT ?????Main particulars of ship Name of Ship FORMTEXT ????Distinctive number or letters FORMTEXT ?????Gross Tonnage FORMTEXT ?????IMO Number FORMTEXT ?????Certificates & Surveys-For each certificate fill the box according to the following letters: I: Initial // A: Annual // In: Intermediate // P: Periodical R: Renewal // Ad: Additional// C: Change of Name, Flag, RO (Specify) OS: Other Services (Specify): FORMTEXT ????? FORMTEXT ????? SOLAS MARPOL FORMDROPDOWN Safety Equipment FORMDROPDOWN IOPP (Annex I) FORMDROPDOWN Safety Radio FORMDROPDOWN CAS Survey FORMDROPDOWN Safety Construction FORMDROPDOWN NLS (Annex II) FORMDROPDOWN Safety Passenger FORMDROPDOWN Sewage (Annex IV) FORMDROPDOWN IMDG-Code FORMDROPDOWN Garbage (Annex V) FORMDROPDOWN IMSB-Code FORMDROPDOWN Air Pollution (Annex VI) FORMDROPDOWN Grain Code (IG-Code)Revision & Approval XYES —NO FORMDROPDOWN Other Certificate (Specify): FORMTEXT ????? FORMDROPDOWN SOPEP (Annex I) / SMPEP (Annex II) FORMDROPDOWN STS Plan (Annex I)Revision & ApprovalXYES---NO FORMDROPDOWN VOC Plan (Annex VI)Stability Booklet FORMDROPDOWN IEEC + SEEMP (Annex VI) FORMDROPDOWN Cargo Securing Manual FORMDROPDOWN BWMP (Ballast Water Management Plan) FORMDROPDOWN Damage Control Plan FORMDROPDOWN CBT (Clean Ballast Tank) FORMDROPDOWN Fire Control Plan FORMDROPDOWN COW (Crude Oil Washing) FORMDROPDOWN Loading Manual FORMDROPDOWN ODMC (Oil Discharge Monitoring & Control System)Stability Booklet FORMDROPDOWN Other Plan/Manual Approval (Specify): FORMTEXT ????? FORMDROPDOWN P&A Manual (Procedure & Arrangement) FORMDROPDOWN Certificate of Type Approval/Type Test Certificate (Specify): FORMTEXT ????? FORMDROPDOWN Other Certificate (Specify): FORMTEXT ????? Load Line Tonnage FORMDROPDOWN ILL-66 FORMDROPDOWN ITC-69Revision & ApprovalXYES —NO Revision & Approval XYES __NO FORMDROPDOWN Freeboard Calculation FORMDROPDOWN Tonnage Calculation FORMDROPDOWN Other Plan/Manual Approval (Specify): FORMTEXT ????? FORMDROPDOWN Other Calculation (Specify): FORMTEXT ?????Certificates & Surveys (Continued)-For each certificate fill the box according to the following letters: I: Initial // A: Annual // In: Intermediate // P: Periodical R: Renewal // Ad: Additional// C: Change of Name, Flag, RO (Specify) // OS: Other Services (Specify): FORMTEXT ????? ILO Conventions (Accommodation of Crews & Lifting Appliances) CICA (ILO-68, 92 & 126) Lifting Appliances (Derricks & Cranes) ILO-152 FORMDROPDOWN CICA FORMDROPDOWN Derricks certification FORMTEXT ???Maximum of crew members according the accommodation arrangements FORMTEXT ????Number of derricks FORMTEXT ?????SWL FORMDROPDOWN Cranes Certification FORMTEXT ????Number of Cranes FORMTEXT ?????SWLOther Certificates Chemical Tankers & Gas Carriers (IBC/IGC Codes) FORMDROPDOWN Caribbean Code (CCSSC) FORMDROPDOWN IBC-Code (Chemical Tankers constructed on or after 1-July-1986) FORMDROPDOWN MODU-Code FORMDROPDOWN IGC-Code (Gas Carriers constructed on or after 1-July-1986) FORMDROPDOWN Special Purpose Ships FORMDROPDOWN High-Speed Craft FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Bollard Pull Certification FORMDROPDOWN Other Certificate (Specify): FORMTEXT ?????Note: Copy of existing certificates and supplements attached to the certificates to be submitted to Class ARS -Head Office including pages with Annual/ Intermediate endorsementsCertification Scenarios FORMDROPDOWN Change of Recognized Organization FORMDROPDOWN Re-activation of Statutory Certificates FORMDROPDOWN Change of Flag / Change of Ship?s Name FORMDROPDOWN Other Scenario (Specify): FORMTEXT ?????Class ARSQP 3.1-1/F1Revision No.25791200874839500 ................
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