MALAYSIA SHIPOWNERS ASSOCIATION Form C

DOMESTIC SHIPPING LICENCE EXEMPTION INFORMATION FORM Offshore Vessel

√ Please tick in the relevant box.

1 VESSEL REQUIREMENT:
a) Vessel Name : (Potential / candidates vessel name)

b) Type of Vessel :
c) No. of Vessel Required : 1

2 Project Details
a) Project Name :
b) Approval Reference Number :
c) Location :
d) Project Requirement :

3 COMMENCEMENT DATE:
a) Laycan :
b) Duration :

4 DESCRIPTION OF VESSEL: Critical Project Requirement

(To indicate restriction if any) (Tick in the box)
a) Length (min - max) : Yes No
b) Breadth (min - max) : Yes No
c) Depth (min - max) : Yes No
d) GRT (min - max) : Yes No
e) NRT (min - max) : Yes No
f) DWT (min - max) : Yes No
g) Critical Specs for Project :

*I hereby confirm that the above informations are true and complied to
Part IIB of Merchant Shipping Ordinance MSO 1952

5 APPLICANT'S DETAILS
Applicant's Details Charterer's Details
a) Name : a) Name :
b) Company : b) Company :
c) Address : c) Address :

d) Tel/Fax/Hp No. : d) Tel/Fax/Hp No. :

e) Email Address : e) Email Address :

f) MASA Member : f) MASA Member :

Yes No Yes No