MARINE DEPARTMENT MALAYSIA

SHIPPER REGISTRATION FORM

FOR VERIFIED GROSS MASS OF A PACKED CONTAINER (REV. 2)
NEW RENEWAL AMENDMENT CANCELATION

Company’s Name :

Company’s Address :

Telephone & Fax No. : Tel: Fax:

Email Address :
Full name of a Duly Authorised Officer¹ :

Please tick (√) on box of selected method for obtaining the verified gross mass of a packed container.
Please submit complete application to the nearest Marine Department Regional Office (Shipper
Registration Office) for manual submission or email to our officer in-charge (kindly refer to the list of
Shipper Registration Office).

METHOD 1 METHOD 2

Weighing Station : (please stated) Weighing Station : (please stated)

OR
Using Port Terminal Facilities only²
(submission of Form D is not required).
Please attach the following documents :
1 A complete registration form.
2 A copy of Company Registration Certificate.
3 A copy of Malaysian Identity Card of Duly
Authorised Officer.
4 A copy of Form D³ of weigh equipment for
obtaining the verified gross mass of a
packed container.
Please attach the following documents :
1 A complete registration form.
2 A copy of Company Registration Certificate.
3 A copy of Malaysian Identity Card of Duly
Authorised Officer.
4 A copy of Form D³ of weigh equipment for
obtaining the verified gross mass of a
packed container.
5 A copy of Quality Management Certificate⁴.

DECLARATION
I/We hereby declare that the above information and submitted documents are true. If any of those
information or documents submitted is found to be incorrect, the Marine Department has the right to
refuse or cancel the application.

Applicant’s signature;

.................................................. Company’s
Full Name : stamp
Designation :
Mykad No. :
Date :

¹ Duly Authorised Officer is the appointed person to sign the shipping document (min. One person).
²Port Terminal Facilities means Port Terminal weighing equipments (i.e Weigh Bridge).
³Form D is the ‘Perakuan Penentuan Timbang dan Sukat, Akta Timbang dan Sukat 1972’.
⁴Quality Management Certificate (i.e ISO 9001).

For more information visit our website at www.marine.gov.my or http://shipper.marine.gov.my