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MALAYSIA SHIPOWNERS' ASSOCIATIONForm A
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DOMESTIC SHIPPING LICENSE CONSENT LETTER INFORMATION FORMBunkering
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√
Please tick in the relevant box.
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VESSEL REQUIREMENT:
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a)Vessel Name:
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BASIC INFORMATION:
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a)Type:Specs:
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b)Type of Cargo:
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c)Cargo Quantity:
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d)
Load Port / Terminal
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e)
Off Loading Terminal
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d)
Recepient Vessel/Location
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e)
Type of Charter
Voyage Charter
Time Charter
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f)Charterer :
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g)
Port Authority /
:
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Marine Dept Approval Letter
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h)
PDA License Number
:Area:
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COMMENCEMENT DATE:
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a)Laycan:
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b)
Duration (Days)
:
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DESCRIPTION OF VESSEL:
Critical Project Requirement
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(To indicate restriction if any)
(Tick in the box)
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a)Length
(min - max)
:YesNo
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b)Breadth
(min - max)
:YesNo
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c)Depth
(min - max)
:YesNo
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d)GRT
(min - max)
:YesNo
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e)NRT
(min - max)
:YesNo
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f)DWT
(min - max)
:YesNo
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g)Pumping rate:YesNo
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APPLICANT'S DETAILS
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Applicant's Details
Charterer's Details
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a)Name:a)Name:
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b)Company:b)Company:
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c)Address:c)Address:
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d)Tel/Fax/Hp No.:d)Tel/Fax/Hp No.:
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e)Email Address:e)Email Address:
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f)MASA Member: f)MASA Member:
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YesNoYesNo
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