Form No.

: DSO-03
Revision No:/Date: 0/13 June 2002

Domestic Shipping Office

SCREENING OFFICER’S CHECKLIST FOR THE
APPLICATION FOR SPECIAL PERMIT/EXEMPTION PERMIT/RENEWAL/EXTENSION OF
SPECIAL/EXEMPTION PERMIT

Y N
1. Letter of Application
2. Fixture Note/Contract of Affreightment/Time/Voyage Charter Agreement
3. Duly notarized Resolution of the company’s Board of Directors, certified by
the Board Secretary, authorizing the filing of the application and designating
the officials/authorized representatives to represent the applicant-
company/registered owner
4. Valid Certificate of Vessel’s Original Registry/ Nationality (for foreign flag
only)
5. Class Certificate/Latest Survey report
6. Crew list indicating STCW certificates (number and validity) of the crew
required certification.
7. Certified true copy of the TOVALOP (except LPG carriers) and P & I
Coverage
8. SEC Registration (for branch offices of foreign owners/charterers/vessel
representative)
9. Other related documents/contracts that would trace the operation/project
involving the utilization of the vessel (if there are two or more other
companies involved in the project)

Post-Approval Documentary Requirements

1. Duly notarized/authenticated Fixture Note/Contract of Affreightment/Time or
Voyage Charter Agreement (notarized only if document is executed in the
Philippines)

_____________________________________
Screening Officer (signature over printed name)
Date:
Application Control No.: (to be copied by Records from the DtrackS Form No. 1)
Action Taken: ___________________________ Amount P________________ OR#___________
Remarks: ________________________________________________________________________
_________________________________________________________________________________
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