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APPLICATION FOR MINIMUM SAFE MANNING CERTIFICATE SHIP S DETAIL NAME OF SHIP OFFICIAL NUMBER LENGTH OVERALL IMO NUMBER DEPTH NO. Application will be reviewed by the Department of Safety Environment and Certification and a Minimum safe Manning Certificate under the authority of the Shipping Act 1998 will be issued provided all necessary information requested has been provided. PARTICULARS OF OPERATING COMPANY INFORMATION SAME AS DOCUMENT COMPLIANCE Name of Operating Company Address of Operating Company Telephone Fax No Email Address Contact Person Company Identifiers No I certify that to the best of my knowledge the particulars given by me in this form are correct. GENERATORS UNMANNED MACHINERY SPACE UMS CERTIFICATE YES Deck Engine Two GROSS TONNAGE ITC 69 PROPELLING ENGINES DESCRIPTION OF ENGINE S WATCH SYSTEM TRADING AREA REGISTER DIMENSION BEAM Automated Mooring Winches Yes TYPE OF SHIP No NO NO. OF ENGINE S BHP/KW PROPULSION SPEED KNOTS Total No* of Persons for which Life Saving Appliances are provided OTHER DETAILS Inter Communication system Yes Automatic Pilot Yes Three PROPOSED MANNING SCHEDULE GRADE/CAPACITY Deck Officers Master Chief Officer OICNW CERTIFICATE STCW REG* NUMBER OF PERSONS II/2 or II/3 1 Deck Ratings Able Seafarer Deck Rating forming part of a Navigational Watch Other Deck Ratings II/5 II/4 VI/1 and VI/6 Engine Officers Chief Engineer Second Engineer OICEW Electro-Technial Officer III/1 III/6 Engine Ratings Able Seafarer Engine a Engine Watch Miscellaneous Cook Other Engine Ratings III/7 Owners should attach all supporting document s. GENERATORS UNMANNED MACHINERY SPACE UMS CERTIFICATE YES Deck Engine Two GROSS TONNAGE ITC 69 PROPELLING ENGINES DESCRIPTION OF ENGINE S WATCH SYSTEM TRADING AREA REGISTER DIMENSION BEAM Automated Mooring Winches Yes TYPE OF SHIP No NO NO. OF ENGINE S BHP/KW PROPULSION SPEED KNOTS Total No* of Persons for which Life Saving Appliances are provided OTHER DETAILS Inter Communication system Yes Automatic Pilot Yes Three PROPOSED MANNING SCHEDULE GRADE/CAPACITY Deck Officers Master Chief Officer OICNW CERTIFICATE STCW REG* NUMBER OF PERSONS II/2 or II/3 1 Deck Ratings Able Seafarer Deck Rating forming part of a Navigational Watch Other Deck Ratings II/5 II/4 VI/1 and VI/6 Engine Officers Chief Engineer Second Engineer OICEW Electro-Technial Officer III/1 III/6 Engine Ratings Able Seafarer Engine a Engine Watch Miscellaneous Cook Other Engine Ratings III/7 Owners should attach all supporting document s.

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