APPLICATION FOR

MOU MINIMUM SAFE MANNING CERTIFICATE

(***Incomplete applications will be declined***)

A. GENERAL INFORMATION

Applicant Name / Address /Phone / e-

Name of Unit:      
mail:
      Name of Unit:
     
Keel Laying
Date:      

Call Letters:
     
Unit’s IMO No.:
     

Gross Tonnage
     
(ITC`69):

* Operating Company Name :

Copy of Safety Management Certificate, shall be submitted if
applicable
Name of Company and person (E-mail      
address) responsible for paying invoices:
     

Description and Functions of MOU

Unit Certificated with MLC Rules YES N/A NO
Unit with HUNDRED (100) persons certificated STCW
YES N/A NO
(seafarers)
Unit with at least TEN (10) seafarers (certificated STCW) YES N/A NO
Master, Chief Mate and deck officers holding GMDSS license YES NO
Unit full equipped with GMDSS YES NO
(Accordiing to SOLAS Chapter IV)
At least TWO (2) GMDSS General or Restricted operators YES NO
underway
ONE (1)
ONE (1) or TWO (2) GMDSS General operators On-Location
TWO (2)
TWO 2-watch system
Watch shift system adopted underway and On-Location
THREE 3-watch system
YES NO
Ballast or Preload Tanks System

YES NO
Master licensed as OIM

Offshore service engaged      

Jurisdictional operation area      

SEG-01-01 Pag. 1 / 3
Rev. March. 2021
 APPLICATION FOR
MOU MINIMUM SAFE MANNING CERTIFICATE
(***Incomplete applications will be declined***)

B. LIFEBOATS FOR THE AGGREGATE CAPACITY 100%

LB TYPE LB No. LB Certified Capacity Number of Certificated Persons

                       
                       
                       
                       
                       

C. MOU CERTIFICATION

Pre-1979 1979 1989 2009

SOLAS MODU Safety Certificate MOU Safety Certificate

(Drilling or Non-Drilling Units) (Non-Drilling Units)

D. MACHINERY

If self-propelled, engine’s power (Kw)

Unit Certified with UMS YES NO
Unit fitted with Dynamic Positioning System (DPS) YES NO
Unit fitted with thrusters to assistance in maneuvering YES NO
Underway voyages more than 600 nm YES NO (less than 600 nm)
If non-self-propelled, but with thruster machinery and/or systems used only for
Maintaining position and heading (DPS) YES NO
Short field moves YES NO
Providing assistance under tow YES NO

E. TYPE OF UNIT & MODES OF OPERATION

TYPE OF UNIT MODES OF OPERATION

1. Self-Elevating Vessel On Location
1.1. Self-Elevating Unit
1.2. Liftboat A. Bottom Bearing (On-Location offshore)
2. Column Stabilized Unit
C. Afloat ( Moored with anchors /
2.1. Submersible mooring system)
2.2. Semi-Submersible D. Afloat (Positioned Dynamically)
2.3. Cylindrical In Transit
SEG-01-01 Pag. 2 / 3
Rev. March. 2021
 APPLICATION FOR
MOU MINIMUM SAFE MANNING CERTIFICATE
(***Incomplete applications will be declined***)

3. Surface Unit A. Under Tow

3.1. Drillship B. Underway (select below)
3.2. Drilling Tender Unit B.1. Underway 0 to 8 hours
3.3. Drilling Tender Barge B.2. Underway 9 to 16 hours
3.4. FPSO / FSU B.3. Underway 17 hours to 72 hours
3.5. Other B.4. Underway more than 72 hours

SEG-01-01 Pag. 3 / 3
Rev. March. 2021