1. Fill in applicant’s name.

2. Under column “Declaration”, delete what is not applicable.

3. Under column “Type of Audits/Review Required:” , tick “Document Review”.

4. Under column “Type of Certification required”, tick “Interim DOC”.

5. Propose date for the Document Review in column “Proposal date for review/audit: “.

6. Initial and fill up the requested information.

7. For questionnaire 1 to 4, please fill up the latest information requested. Should the space provided insufficient, please attached accordingly.

8. For questionnaire 5, the Company is required to fill up the column provided. The Company may also attach a separate form that contains at least the requested information.

9. “RO issuing SMC” referring to any Recognised Organisation that issues the Safety Management Certificate (SMC) to the particular vessel.

10. For questionnaire 6 – (attachments),for New Application, attached all of the requested in formations. Please refer below:

a. Item a) referred to the Company’s Policies with regards to Safety and Environmental Protection.

b. Item b) referred to Company’s Organisation Chart that shows clearly the relationship and authority among the shore based and ships base staffs as well as the direct line of communication between highest management and DPA.

c. Item c) referred to Job responsibilities and authority for shore based and ship base personals, ranging from the highest management and ship’s master.

d. Item d) referred to emergency contact number for shore staff and other related government agencies.

e. Item e) referred to implementation program for the Company’s Safety Management System, shore base and ship base.

f. Item c) referred to any full term DOC that the Company currently hold.

11. Completed form may be submitted via fax (+603-3168 4454) or e-mail to ism@marine.gov.my or by hand to Assistant Principal Director, Ship Safety Management Unit.

12. For case to case basis, we may require the Company to submit further information.

DOCUMENT REVIEW (NEW APPLICATION):

Should the Company carried out major changes to their Safety Management System, additional Document review is required. The application procedure as follow:

1. Fill up the applicant’s name.

2. For column “Declaration”, delete where applicable.

3. For column “Type of Audits/Review Required:” , tick “Document Review”.

4. For column “Type of Certification required”, tick “Interim DOC” or “Document of Compliance”, which ever applicable.