THE REPUBLIC OF LIBERIA

APPLICATION FOR MINIMUM SAFE MANNING CERTIFICATE FOR

SHIPS WHICH MUST COMPLY WITH THE STCW REQUIREMENTS

NAME OF OWNER/OPERATOR: PRESENT SHIP NAME:

ADDRESSS: PREVIOUS SHIP NAME:

O.N: IMO NUMBER:

PHONE: FAX:

EMAIL:

DATE BUILT: GROSS TONS: NET TONS:

VESSEL TYPE:

TRADING AREA(S):

NO NUMBER OF MAIN ENGINES: STEAM or MOTOR TYPE OF BOILERS:

TYPE OF MOTOR: TOTAL KW PROPULSION:

NO. OF GENERATORS: TOTAL KW GENERATORS:

CLASSIFICATION SOCIETY:

INDICATE CLASS NOTATIONS FOR UNATTENDED MACHINERY OPERATION, IF ANY:

INDICATE CLASS NOTATION FOR INTEGRATED BRIDGE SYSTEMS, IF ANY:

NO. OF LIFEBOATS: NO. OF RESCUE BOATS:

NO. OF LIFERAFTS: LIFERAFTS WITH LAUNCHING

APPLIANCES:

OWNERS MINIMUM MANNING PROPOSAL ___Master

___ Chief Mate

___ Navigational Watch Officer

___Other (Describe)

_________________________

___Able Seaman/Able

Seafarer Deck

___ Ordinary Seaman

___Other (Describe)

_________________________

____Chief Engineer

____ Second Engineer

____Engineering Watch Officer

____Other (Describe)

__________________________

___ Oilers/Motorman/Able

Seafarer Engine

___ Fitter

___ Other (Describe)

______________

The proposal shall take into account IMO Assembly resolution A.1047(27) and will be reviewed by Marine Safety

Division. A minimum Safe Manning Certificate will be issued under authority of Maritime Regulation 10.292(5),

provided all necessary information requested of owner has been provided. Proposals for reduced manning should attach

additional information the owner feels supports his proposal. Catering Department personnel are not included in minimum

safe manning unless they are trained general purpose personnel.

Print Name of Submitter: __________________________________________

(Applicant should be a nominated Decision Maker for the above Vessel).

Signature of Submitter: ___________________________________________

Title: __________________________________ DATE: ____________________

Mail Application To: Liberia Maritime Authority

c/o Liberian International Ship and Corporate Registry Attn: Marine Safety Division 22980 Indian Creek Drive, Suite 200, Dulles, VA 20166, USA

Telephone: (703) 790-3434 Fax: (703) 790-5655

MSD 336RL 05/13