ABS | The American Bureau of Shipping



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@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 ?????Company Name FORMTEXT ?????Address FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????CityState or CountryPostal Code FORMTEXT ????? FORMTEXT ?????Contact PersonTitle FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????PhoneFaxEmailCORRESPONDENCE ADDRESS? SAME AS PHYSICAL FORMTEXT ?????Company Name FORMTEXT ?????Address FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????CityState or CountryPostal Code FORMTEXT ????? FORMTEXT ?????Contact PersonTitle FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????PhoneFaxEmail2. Company Shore-side OrganizationLocationEffective Number of PersonsTotalMgt./AdminOperationsM&R / TechnicalPersonnel / CrewingHead office: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Branch office: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Branch office: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Branch office: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Branch office: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3. Fleet InformationFleet Breakdown by Vessel TypeVessel TypeNo.Crew SizeCrew NationalityWorking LanguageTrade Routes(Coastal/International)Registries(Flag)Passenger Ship FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Passenger High Speed Craft FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Cargo High Speed Craft FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Bulk Carrier FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Oil Tanker FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Chemical Tanker FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Gas Carrier FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Mobile Offshore Drilling Unit FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other Cargo Ship: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other Cargo Ship: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other Cargo Ship: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other Cargo Ship: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Fleet Breakdown by Class Society SocietyABSDNVLRBVNKGLRINAOthers: FORMTEXT ?????Number of Vessels FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Vessel InformationVessel NameVessel TypeVesselIMO 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 ?????4. Planning InformationProjected Date:Manual Review: FORMTEXT ?????Interim Certification Audit: FORMTEXT ?????Initial Certification Audit: FORMTEXT ?????5. ISM CertificationCertificates granted under the program include an ISM Document of Compliance (DOC) for the shore side operation and ISM Safety Management Certificates (SMCs) for each ship. The DOC will be issued upon satisfactory completion of the office assessment process. Subsequently, SMC’s will be issued to individual ships upon successful assessment. Certificates are issued for a five year term.? Please provide “Application for Marine Management System Certification" with an estimate for the requested service.6. Optional Certification SchemeABS also offers certification to ABS Guide for Marine Health, Safety, Quality and Environmental and Energy Management (HSQEEn Guide) in conjunction with ISM Code certification. The HSQEEn Guide is designed to meet or exceed the requirements of the ISM Code, ISO 9001, ISO 14001, ISO 50001 and OHSAS 18001 standards. Upon certification, ABS issues the following certificate(s) and/or Notation(s): Certificate of Company Compliance – indicating company compliance with applicable requirements of ABS HSQEEn Guide is issued for a period of five years. Certificate of Vessel Compliance – indicating vessel compliance with applicable requirements of ABS HSQEEn Guide is issued for a period of five years.Notation – issued to ABS-classed vessel to recognize that it conforms to the designated requirements of HSQEEn Guide.Does your Company want certification to the ABS Guide?YesNo FORMCHECKBOX FORMCHECKBOX Certification Information:In addition to the minimally required Safety “S” Certification under the Guide, please indicate if your company would like any of the other certification options listed below: FORMCHECKBOX Q (Quality) FORMCHECKBOX E (Environmental) FORMCHECKBOX En (Energy) FORMCHECKBOX H (Health)Note: Pre-assessment (STAGE 1) is required for Q, E, H or En certification.Additional Information for Energy (En) Certification:a) Total amount of energy used annually in BBTUs: FORMTEXT ?????b) Total number of energy sources within the scope of certification: FORMTEXT ?????Check all Energy sources that applyNatural GasElectricityHeavy Fuel OilMarine Diesel FuelMarine Gas FuelOther(please specify)Shore based: FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Shipboard: FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????c) List Significant Energy Uses: FORMTEXT ?????d) Scope & Boundary of EnMS Certification FORMTEXT ?????7. Optional Accredited ISO CertificationAs an alternative to the ABS HSQEEn Guide certification, ABS Quality Evaluations (ABS QE) offers accredited ISO certification. The schedule of fees for this service can be provided by ABS QE upon request.Would you like ABS QE to contact you for the accredited certification?YesNo FORMCHECKBOX FORMCHECKBOX ABS Use OnlyDivision Received By: FORMTEXT ?????Reviewed By: FORMTEXT ????? ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download