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    Appendix 3 (Application Form) : Stamp of Shipowner

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    This document contains an application form for issuance of a Declaration of Maritime Labour Compliance (DMLC) Part 1. The application includes fields for ship details like name, IMO number, type; owner/manager details; and means of financial security for repatriation and liability. It requires the applicant to declare if the ship is subject to any exemptions from MLC 2006 requirements. The fee for a DMLC Part 1 is also listed. Accompanying documents like evidence of registration and financial security must also be provided.

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    Appendix 3 (Application Form) : Stamp of Shipowner

    Uploaded by

    CSB
    162 views2 pages
    This document contains an application form for issuance of a Declaration of Maritime Labour Compliance (DMLC) Part 1. The application includes fields for ship details like name, IMO number, type; owner/manager details; and means of financial security for repatriation and liability. It requires the applicant to declare if the ship is subject to any exemptions from MLC 2006 requirements. The fee for a DMLC Part 1 is also listed. Accompanying documents like evidence of registration and financial security must also be provided.

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    Application_Form_ DMLC_Part1

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    This document contains an application form for issuance of a Declaration of Maritime Labour Compliance (DMLC) Part 1. The application includes fields for ship details like name, IMO number, type; owner/manager details; and means of financial security for repatriation and liability. It requires the applicant to declare if the ship is subject to any exemptions from MLC 2006 requirements. The fee for a DMLC Part 1 is also listed. Accompanying documents like evidence of registration and financial security must also be provided.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    162 views2 pages

    Appendix 3 (Application Form) : Stamp of Shipowner

    Uploaded by

    CSB
    This document contains an application form for issuance of a Declaration of Maritime Labour Compliance (DMLC) Part 1. The application includes fields for ship details like name, IMO number, type; owner/manager details; and means of financial security for repatriation and liability. It requires the applicant to declare if the ship is subject to any exemptions from MLC 2006 requirements. The fee for a DMLC Part 1 is also listed. Accompanying documents like evidence of registration and financial security must also be provided.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 2

    Appendix 3 (Application Form)

    APPLICATION FORM FOR ISSUANCE OF DECLARATION OF MARITIME


    LABOUR COMPLIANCE (DMLC) PART 1
    Name of Ship IMO Number Gross Tonage

    Ship Type

    Official Number or Call Sign


    Name of MLC Shipowner
    (In Accordance with MLC 2006)
    Has the manager assumed and
    agreed to the shipowners duties YES / NO / NOT APPLICABLE*
    and respondsibilities under MLC (delete as applicable)
    2006?
    Is the vessel subjected to any
    substantial, exemption or extension
    from MLC 2006, Title 3 YES / NO
    (If yes, please attach with notice MSN 5/2008 or any
    (Accomodation) reqirements or document related)
    any other under MLC 2006
    requirements?
    What is the means of financial
    security for seafarer's repatriation
    in accordance with Regulation 2.5? (Please provide evidence of financial security document)
    What is the means of financial
    security for seafarer's sickness,
    injury or death in accordance with
    Regulation 4.2? (Please provide evidence of financial security document)
    Reason of application INITIAL / RENEWAL CERTIFICATE
    *Please attach with the valid Ship Registration Certificate, Safety Management Certificate or Document of
    Compliance, and other documentary evidence of financial security for Repatriation & Shipowner's Liability

    Stamp of Shipowner

    Signature:

    Name :
    Position in Company:
    Name of Company:
    Date:

    The fee for DMLC Part I is RM345.00 through money order/companies cheque/ bank draft under name AKAUNTAN
    NEGARA MALAYSIA - MOT - T during the collection time (self services). The application form can be summit by email or
    post to Deputy Director of Seafarers Development Unit , Seafarers Affairs and Port Division ,P.O. Box 12, Jalan Limbungan ,
    42007 Port Klang, Selangor, MALAYSIA, email : [email protected] or [email protected]
    Appendix 4 (Sample Declaration of MLC Shipowner)

    Change to MLC SHIPOWNER LETTER HEAD

    DECLARATION OF SHIPOWNER IN TERMS OF THE MARITIME LABOUR


    CONVENTION,2006 (As Amended)

    Under the Maritime Labour Convention , 2006 the shipowner has to be identified for the purposes of
    the DMLC Part II and the Maritime Labour Certificate. In accordance with article II (1) (j) of the
    MLC 2006; 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 shipowner in accordance with the Convention, regardless of whether any
    other organization or person full fill certain of the duties or responsibilities on behalf of the
    shipowner.

    The undersigned affirms that:

    Name of MLC Shipowner


    (Subject to Request applicability :
    DOC Holder / Registered Owner)
    Company IMO Number
    (Subject to Request applicability - :
    DOC Holder / Registered Owner)
    Contact Person :
    Address :
    Telephone / After Office Hour :
    Fax :
    Email :

    Is the owner of the following Malaysian registered ship (s) :

    NO. SHIP NAME OFFICIAL NO OR CALL SIGN IMO NUMBER


    List down all the ships

    It is hereby declared that the above named owner has assumed the duties and responsibility under be
    taken in operation of the ship in accordance with provisions of MLC, 2006.

    Signature :..................................................................
    Name :....................................................................
    Title :...................................................................
    Place :....................................................................
    Date :.................................................................... (Seal or stamp by Shipowner )

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