DE: PANACONSUL LONDRES

NAVE: A-1

CONSULATE GENERAL OF PANAMA

40 HERTFORD STREET, LONDON W1J 7SH

TEL: + 44 20 7409 2255/FAX: + 44 20 7493 4499

APPLICATION FOR FIRST REGISTRATION, RE-REGISTRATION (CHANGE OF OWNERSHIP) AND CHANGE OF NAME OF A VESSEL

It is advisable that care be taken to avoid incomplete or inexact details, as this can cause additional expense at later date.

(This form must be typewritten)

`(Lodge pages 1 - 5)

GENERAL INFORMATION

1.1Full name or corporate style and address of prospective owner:

1.2Full address, e-mail and telephone numbers of individual/company who will be responsible for payment of future shipping taxes directly to this office on permanent basis:

1.3If legal owner to be a Panamanian Corporation, state registration data at Public Registry (Filing Card; Document or Roll; Entry or Frame). - If prospective owner a Foreign Corporation, state only country of incorporation:

1.4Name and Address of Lawyers in Panama.

E-mail

Telephone:

PARTICULARS OF VESSEL

1.5Alternative names of vessel under Panamanian flag:

1. -

2. -

3. -

NOTE: State (Next to alternatives above) name of Consulate or name of Panamanian law firm who has effectively reserved name of vessel. If lawyer has reserved name, write full style of law firm:

1.6Former names and corresponding nationalities: (Every name of vessel in quotation makes followed by flat in parenthesis: write every single name, beginning with present name at 1. - and ending with hull number at 6. -)

Example: 1. - "QUEEN MARY" (Greece)

1. -

2. -

3. -

Classification Society:

Class:

IMO NUMBER:

1.7 Name of Builders of the vessel/Address & Year of Construction:

1.8Classification Society:

1.9 Number of:

a)Main Decks:

b)Main Masts:

c)Main Funnels:

NOTE: Do not include any accessories such as derricks, radars, signal masts, etc.

1.10Indicate whether Motor or Steamship:

1.11Tonnages: - Net:

- Gross:

- DWT:

- Under Deck

*Specify if according to Bill of Sale, Builders Cert, other documents.

1.12Of what material is the hull made?:

1.13Main dimension in metres or feet:

Main length:

Main breadth:

Main depth:

*Please specify according to which document as in the tonnages.

1.14Propulsion System

- Number of engine(s) (Only main engine(s), not auxiliaries, unless vessel is not self-propelled):

- Type of engine(s):

-Total number of Cylinders:

Length of stroke of each cylinder (in millimeters or inches):

- Diameter of each cylinder in mm. or inches:

- Full name and address of builder of engine(s):

-Place and date where engine(s) were built:

-Speed (knots) of vessel:

-Horsepower of engine(s) (State whether BHP, IHP, SHP or NHP):

1.15RADIO

Full name, address, E-mail and telephone numbers of company and/or person(s) responsible for radio account transmissions (totally or partially):

Please only use the Companies authorized by Panama, if you do not have the list please enquire at this office.

-Specify if vessel is fitted with radio - telegraphy or radio - telephony equipment, or with both:

-Specify if a Selective Call Sign is required:

*Only for vessel with telex machines installed aboard.

YES:NO:

1.16Type of vessel: M/V, M/Y, S/T, S/S, M/T, LPG, Non-propelled etc)

1.17Type of business of vessel: (eg, General Cargo, Bulk Cargo, Gas Cargo, Oil Transport, Supply, Drilling, Exploration, Towing, Commercial Fishing, Passenger, Cargo and Passenger, Pleasure etc).

1.18If Merchant vessel please indicate:

(a)Type of cargo (eg, Dry, Liquid, Gas and Refrigerated):

(b)If oil, state type (Crude etc):

(c)International, Inland, Coaster, etc:

1.19State whether or not dual purpose (e.g., Passenger, Cargo):

YES:NO:

If yes, please specify:

1.20If passenger vessel, state class (e.g., 1st, 2nd, 3rd):

1.21List all names of vessels under your principal's management or agency, with a view to combined billing of annual shipping taxes:

1. -

I HEREBY DECLARE THAT THE ABOVE INFORMATION IS CORRECT TO THE BEST OF MY KNOWLEDGE.

......

Applicant's name in print

......

Signature of Applicant

Full date of signing this form (Day, Month, Year):