CURRENT SHIP NAME / SHIPYARD ID*
FORMER NAME(S)
ORIGINAL NAME*
FLAG* PORT OF REGISTRY CALL SIGN
MMSI _______ OFFICIAL NUMBER* _______ DATE OF FLAG REGISTRATION
TONNAGE (69 CONVENTION) YES NO FISHING NUMBER+ ________
GROSS* _________ NET* ________ DEADWEIGHT ________
LENGTH OVERALL* _______ LENGTH B.P. ______________
EXTREME BREADTH* MOULDED BREADTH ______________
MOULDED DEPTH DRAUGHT ______________
DATE OF KEEL LAYING DATE OF LAUNCH DATE OF COMPLETION*
SHIPBUILDER* PLACE OF BUILD* HULL No.*
SUB-CONTRACTOR BUILDER (if applicable) HULL No.
SHIP TYPE DESCRIPTION* HULL MATERIAL
(MARPOL requirements The ship complies with regulation 13F(3) (double-hull) Yes No
for OIL TANKERS) The ship complies with regulations 13 and 13E (SBT/PL) Yes No Other (please specify) ______
The ship is subject to CAS requirements of regulation 13G(7) Yes No
REGISTERED OWNER† & ADDRESS† MANAGER† & ADDRESS†
(Including Fax, Telephone & Email) (Including Fax, Telephone, Email & Website)
NUMBER OF MAIN ENGINES ENGINE TYPE MANUFACTURER
CURRENT CLASS SOCIETY TOTAL BHP NUMBER OF PROPELLERS
COMPANY REQUESTING IMO NUMBER
COMPANY NAME* CONTACT NAME *
SENDER’S EMAIL* SENDER’S FAX NUMBER *
[* Required Fields – all ships] [ † Required Fields – Ships in service only]
Note: We cannot issue an IMO Ship No. without the above fields
[+ Distinctive Number or Letters for Fishing Vessels]
FOR OFFICE USE ONLY IHS-M (10/06)
DATE RECEIVED ______________ IMO REF. NO. _____________ REFERRED TO ______ BY ______
ACTIONED BY ______________ DATE ______________ IMO NUMBER ______________