1.      Fill in applicant’s name.

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

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

4.      Under column “Type of Certification required”, tick “Document of Compliance”.

5.      Under column “Proposal date for review/audit: “ state the date you want the audit to be conducted.

6.      Initial and fill up the requested information.

7.      For questionnaires 1 to 5, please provide the information as requested. Should the space provided is insufficient, you may enclosed the information in separate attachment.

8.      “RO issuing SMC” refers to the Recognised Organisation that issues the Safety Management Certificate (SMC) to the particular ship.

9.    For questionnaire 6 – (attachments), only if necessary.

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