Voluntary

Application forReview of Relevant Documents (DMLC Part II and/or drawings) and Inspection of Seafarers’ Working and Living Conditions
Date:

To NIPPON KAIJI KYOKAI

/ ( SMD )
(Please submit this Application to ClassNK SMD): E-mail : Fax:+81-3-5226-2174
APPLICANT (MLC Shipowner[i])
Name:
Address:
Person in charge: / Signature:
Telephone No.: / Fax No.: / Mobile:
E-mail:
We acknowledge the provisions of National laws/requirement implementing MLC,2006 and request you to carry out a review andreviewof our Relevant Documents on Maritime Labour (DMLC Part II and Drawings on Accommodation & Recreational Facilities) / to carry out an inspection and to issuea certificate ( SOC ) for the Seafarers’ Working and Living Conditions as detailed below:
Name of ship: / Gross Tonnage:
Classification Society: / Class No.:
IMO Number: / Port of Registry:
Flag: / Official No.:
Call sign: / Constructed (keel laid) Date:
Type of Ship:
Documents Review or Notification of changes
Initial review / Amendments to an reviewed Documents / Notification of changes to an reviewed Documents ( Review not required)
Shipboard Inspection as voluntary basis as comprehensive as
Initial Verification
AdditionalVerification
for ()
Date: / Place:
Name of Agent: / E-mail:
Telephone No.: / Fax No.: / Mobile:
The master is familiar with the responsibility to implement and the requirements of MLC,2006 : yes (agreed)
Appointed person by the company to accompany the inspector: from ashore Master C/O C/E, other:()
All fees and expenses incurred in the above mentioned inspection and issuance of certificate are/will be paid by;
Name:
Address:
Telephone No.: / Fax No.: / E-mail:
Applicant’s Name:
Attached:
*1 / *2
Copy of DMLC Part I issued by the Flag Administration
1 set of DMLC Part II(including relevant documents, if any) and Drawings on Accommodation & Recreational Facilities or document certify to conform to C92/133 or national regulations are related to ship’s accommodation and recreational facilities such as certificate, inspection report or other similar document if any.
Copy of Certificate of Registry

*1: to be attached in case of DocumentsReview, including its amendments / *2: to be attached in case of Shipboard Inspection

MLC-APPLI-voluntary (2012-01)

[i]MLC Shipowner means the owner of the ship or another organization or person, such as the manager, agent or bareboat charterer, who has assumed the responsibility for the operation of the ship from the owner and who, on assuming such responsibility, has agreed to take over the duties and responsibilities imposed on shipowners in accordance with this Convention, regardless of whether any other organization or persons fulfill certain of the duties or responsibilities on behalf of the shipowner. It is understood DOC Company on ISM Code.