ࡱ>  R`bjbj{{ (rr4,,,h\,;B(rtttttt$}!/$:]Hrr CL^ 0;i$i$i$h;i$r, :  CHINA CLASSIFICATION SOCIETY REQUEST FOR COMPANY CERTIFICATION We hereby request China Classification Society to carry out verification to SMS of the following Company and to issue or endorse Document of Compliance according to ISM Code. We agree to pay the verification fee, any travelling and other expenses occurring in connection with the verification as per the provisions of China Classification Society. During the verification, we promise to provide appropriate health and safety protection for attending auditors in accordance with the applicable mandatory requirements and the recommendations specified in the Health and Safety Protection Guideline for Client of this society. Company Information: Name of Company Identification NumberAddress of registry Address of officeContact PersonDesignated PersonTelephone No.Mobile phone No.E-mailFax No.Designated E-mail Receiving E-CertificateVerification Information FlagShip s Type CoveredKind of VerificationQuantity of ships&PS &PHC &CHC &BC &OT &CT &GC &MOD &OS&Interim &Initial &Annual &Renewal &Additional&PS &PHC &CHC &BC &OT &CT &GC &MOD &OS&Interim &Initial &Annual &Renewal &Additional&PS &PHC &CHC &BC &OT &CT &GC &MOD &OS&Interim &Initial &Annual &Renewal &Additional&PS &PHC &CHC &BC &OT &CT &GC &MOD &OS&Interim &Initial &Annual &Renewal &AdditionalPlace of VerificationDate of VerificationLanguage of AuditCategory of Certificate Paper Certificate& E-Certificate & Paper + E Certificate & Remark: please find the flag state list who entrust to issue E-cert in CCS official website Appendix: %Safety Management Manual%Procedures%List of procedures, instructions & other materials%List of vesselsMarks to be used:  FORMCHECKBOX  Applicable  FORMCHECKBOX  Not Applicable CHINA CLASSIFICATION SOCIETY REQUEST FOR COMPANY CERTIFICATION The results of review of the follow-up corrective action during the last verification(not applicable for interim and initial verifications): The reason for applying an additional auditif applicable Port State+,-49AO l m n ɺxhx[MF;h oOJPJQJo( h5{h ohS+h o5OJPJQJh h oOJPJQJjh o0JOJPJQJUh(hh oOJPJQJh oOJPJQJh5{h oOJPJQJh o5CJaJhS+h o5CJaJhQ5CJaJh5{h oCJOJPJQJh oCJOJPJQJhS+h o5CJOJPJQJh h oCJOJPJQJh oCJOJPJQJ,-OP ) l d$Ifgd!8 - dWD@`- gd o XdVD6^Xgd  $da$gd o$a$gd o $dpa$gd o$a$gd  l m uu d$Ifgd!8~kd$$Ifl40D%O) 0x(44 la8f4yt!8 ( " $ 2 F H J L NRTn  ɼ챤tih oOJPJaJo(jh o0JOJPJQJUh o5OJPJQJhS+h o5OJPJQJ h5{h?Qh5{h?QOJPJQJh?QOJPJQJo(h(hh oOJPJQJh oOJPJQJh oOJPJQJo(h(hh oOJPJQJo( h5{h oh5{h oOJPJQJ' * " uu d$Ifgd!8~kd$$Ifl4 0D%O) 0x(44 la8f4yt!8" $ H J uu d$Ifgd!8~kd8$$Ifl4 0D%O) 0x(44 la8f4yt!8J L j l uuuu d$Ifgd!8~kd$$Ifl4 0D%O) 0x(44 la8f4yt!8 [OOOO d$Ifgd!8kdT$$Ifl4\%D%O ) 0x(44 la8f4yt!8 [OOOO d$Ifgd!8kd$$Ifl4\%D%O ) 0x(44 la8f4yt!8 PR[OO d$Ifgd!8kd$$Ifl4\%D%O ) 0x(44 la8f4yt!8RT sddQdd$d$If^a$gd!8$d$Ifa$gd!8 dWD`gd o~kdR$$Ifl40D%0H0x(44 la8f4yt7x  .Ll[OOOCCO d$Ifgd o d$Ifgd!8kd$$Ifl4\V X!8%j 0l(44 la8f4yt o$&.08:DFLNVXdfjln~  ,.246FHXZƼҼҼҼҰҩƼҼ)h5{h ohr|OJPJQJmHnHu hth oh oOJPJQJ^Jh oOJPJQJh oOJPJQJ^Jh5{h oOJPJQJh oOJPJQJ^JaJh oOJPJaJo(h oPJaJ:4[OOOOOO d$Ifgd okd$$Ifl4\V X!8%j 0l(44 la8f4yt oZ\hln|~ "$046DFHJ`bdfhpr|~̷̷h oOJPJQJ^Jh oOJPJQJ^JaJh oPJaJh oOJPJaJo()h5{h ohr|OJPJQJmHnHu hth oh oOJPJQJh oOJPJQJh5{h oOJPJQJh oOJPJQJ^J6`b[OOOOOO d$Ifgd okd$$Ifl4\V X!8%j 0l(44 la8f4yt obdf(*[OOOOOO d$Ifgd okdh$$Ifl4\V X!8%j 0l(44 la8f4yt o (*,Żѻѻѻѯѥїїub$hRw3hqB*CJPJaJo(phhP\hqCJPJaJhqCJPJaJo(hqCJPJaJ h5{h o hth oh oOJPJQJh oOJPJQJ^Jh oOJPJQJh oOJPJQJ^Jh5{h oOJPJQJh oOJPJQJ^JaJh oPJaJh oOJPJaJo(%*,XZ[OOOO d$Ifgd!8kdB$$Ifl4\V X!8%j 0l(44 la8f4yt o[OOOO d$Ifgd!8kd $$Ifl4\R 8% . 0l(44 la8f4yt!8f[OFF $Ifgdj $$Ifa$gdjkd $$Ifl4\R 8% . 0l(44 la8f4yt!8 ,.2\^`df 8:HJ^`lnprŵؓ~qfq\q\qUqfqUqfqUqfqU h5{h oh oOJPJQJh oOJPJQJo(h5{h oOJPJQJ h5{hqhqB*CJPJaJph$hqhqB*CJPJaJo(phhqCJOJPJQJaJo(hqB*CJPJaJo(ph$hRw3hqB*CJPJaJo(ph!hRw3hqB*CJPJaJph,hRw3hqB*CJOJPJQJaJo(ph! 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Type of ship: please insert the type as below: Passenger ship-PS, Passenger high-speed craft-PHC, Cargo high-speed craft-CHC, Bulk carrier-BC, Oil tanker-OT, Chemical tanker-CT, Gas carrier-GC, Mobile offshore drilling unit-MOD, Other cargo ship-OS.     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