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中国船级社CHINACLASSIFICATIONSOCIETY
APPLICATIONFORCERTIFICATION
(ThisforminduplicatemaybesubmittedthroughthelocalofficeofthisSociety)
WeherebyrequestChinaClassificationSocietytocarryouttvoerSiMfSicoaftitohnefollowingCompany
andtoissuetheInterimDocumentofCompianceorDocumentofComplianceortoendorsethecurrentDocumentofcomplianceaccordingtoISMCode..
CompanyInformation::
NameofCompany
Addressofthecompany(Ifregisteredaddressisn’otperationaalddress,pleasefilloutseparatelythem)
ContactPerson DesignatedPerson
TelNo. FaxNo.
E-mail Postcode
DOCNo(ifhave) Issuedby
KindsofVerification
InitialVerification AnnualVerification
RenewalVerificationInterimVerificationPlaceofVerificationLanguageofAuditVesselscoveredbySMS
TypeofShip
Passengership
Passengerhighspeedcraft
Cargohighspeedcraft
Bulkcarrier
Oiltanker
Chemicaltanker
Gascarrier
Mobileoffshoredrillingunit
Othercargoship
AdditionalVerification
DateofVerification
CompanyidentificationnumberNumberofshipscoveredbyapplyingDOFClag
Appendix:
□Safetymanagementmanual
□Procedures
□Listofprocedures,instructionsothermaterials
□Listofvessels
───────────────────────────────────────────
Weagreetopaytheverificationfee,inaddition,anytravellingandotherexpensesincurredinconnectionwiththeverification.ItisunderstoodthatintheeventofthisprojectnotbeinSocietysverification,theSocietyreservestherighttochargeitsserviceprorata
───────────────────────────────────────────
Markstobeused: Applicable Notapplicable
（Rev.8.11）/3
Form:RWPSM701-A(E)
中国船级社CHINACLASSIFICATIONSOCIETY
APPLICATIONFORCERTIFICATION
Theresultsofreviewofthefollow-upcorrectiveactionduringthelastverificatioforinterimandinitialverifications):
PortStateControlPerformanceofvesselscoveredbyapplyingDOC sincelastaudit(notapplicableforinterimandinitialverification):
ChangeofSMS
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