CURRENT NAME / SHIPYARD ID *

FORMER NAME(S)

ORIGINAL NAME *

FLAG * PORT OF

REGISTRY

CALL SIGN

FLAG

REGISTRATION

DATE

OFFICIAL NUMBER * MMSI

TONNAGE

(69 Convention) Yes No Unknown

FISHING

NUMBER +

GROSS * NET * DWT

LENGTH OVERALL * LENGTH B.P.

EXTREME BREADTH * MOULDED BREADTH

MOULDED DEPTH DRAUGHT

KEEL LAYING DATE LAUNCH DATE

COMPLETION DATE *

SHIPBUILDER * PLACE OF BUILD *

HULL No. *

SUB-CONTRACTOR HULL No.

(if applicable)

SHIP TYPE DESC. * HULL MATERIAL

MARPOL requirements for OIL TANKERS

The ship complies with regulation 13F(3) (double-hull)

Yes No Unknown

/ n.a.

The ship complies with regulations 13 and 13E (SBT/PL) Yes No

Unknown

/ n.a.

Other (please specify)

The ship is subject to CAS requirements of regulation 13G(7) Yes No

Unknown

/ n.a.

REGISTERED OWNER † MANAGER †

ADDRESS † ADDRESS †

FAX FAX

PHONE PHONE

EMAIL EMAIL

WEBSITE WEBSITE

NO OF MAIN ENGINES ENGINE TYPE

MANUFACTURER TOTAL BHP

NO. OF PROPS

CLASS SOCIETY

Company Requesting IMO Number

Company Name *

Contact Name *

Sender's Email *

Sender's Fax No *