Declaration of Designated Person(s) Ashore - ISM Code (Form ISMDP)

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Tuvalu Ship Registry

10 Anson Road #25-16


International Plaza
Singapore 079903
Declaration of Designated Person(s) Ashore – ISM Tel: (65) 6224 2345
Code Fax: (65) 6227 2345
Email: [email protected]
Website: www.tvship.com
(Form ISMDP)

To ensure the safe operation of each vessel and to provide a link between the “Company” and those on board,
every “Company” shall designate person(s) ashore (DPA(s)) having direct access to the highest level of
management. The responsibility and authority of the DPA(s) shall include monitoring the safety and pollution
prevention aspect of the operation of each vessel and ensure that adequate resources and shore-based support are
applied, as required.

The undersigned affirms that:

Name of DPA 24hr Mobile Contact Email


(1)
(2) (alternate)

has/have been assigned as the DPA(s) in accordance to IMO resolution A741(18) Section 4 of ISM code for the
following Tuvalu registered vessel(s)*:

Name of Vessel Official Number RO for SMC IMO Number

and undertaken that the said DPA(s) will be available to the Administration at any time, as follows:

Contact details of the DPA(s) to which official correspondence and materials may be sent to:

Name Of Company Company IMO No.

Telephone Fax Email

Full Address

The undersigned individuals further understand that any change in DPA(s) or RO(s) must be made in writing by
fax/email. Any change will be acknowledged within 24 hours of being received.

Title of DPA Signature Date

Name & Title of Senior Management of “Company” Signature Date

* add additional sheets if required


RO - ABS / BV / DNV / GL / KR / LR / NK / RINA etc. Full list can be found at www.tvship.com
TVR/FORM/APP/ISMDP/2012/REV.1

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