MARITIME AND PORT AUTHORITY OF SINGAPORE

Shipping Division
460 Alexandra Road
#21-00 PSA Building
Singapore 119963
DID: (65) 6375 1932 Fax: (65) 6375 6231
Email: marine@mpa.gov.sg

This form will take approximately 10 minutes to fill in, provided you have the necessary supporting
information ready.
INTERNATIONAL SAFETY MANAGEMENT (ISM) CODE
DECLARATION OF COMPANY

Under the ISM Code, a Company must be declared to the Administration. In accordance with
Section 1.1.2 of IMO Resolution A. 741(18), the ISM code, "Company" means the Owner of a
ship or any other organization or person such as the Manager, or the Bareboat Charter, who has
assumed the responsibility, has agreed to take over all the duties and responsibility imposed by
the Code, the undersigned affirms that:

Name:

Address:

Telephone no.: Fax no.: Email, if any:

is the owner of record of the following registered Ship(s):

Ship Name Official No. IMO No.

In accordance with Section 3.1 of Assembly Resolution A. 741(18), if the entity who is responsible
for the operation of the ship is other than above stated Owner, the Owner must report the full
name and details of such entity to the Administration. If such is the case here, the undersigned
affirms that:

Name:

Address :

Telephone no.: Fax no.: Email, if any :

is the "Company" responsible for all the requirements by the Code for registered Ship(s) listed
above.
____________________
Date

____________________
Director of Owning Company1
1
The declaration in this form may be signed by the owner or by his appointed agent. Where the owner is a corporate
body, the form may be signed by a Director or the Secretary of the corporate body. A copy of the Power of Attorney would
have to be attached together with the Form if the declaration is signed under an appointed agent.