THE KINGDOM OF CAMBODIA
ISROC
International Ship Registry of Cambodia
______
APPLICATION FOR SHIP REGISTRATION
Registration Type ( √ ) : Regular ( ), Special ( ), BBC IN ( ), Yacht ( ), Fishing ( )
DESCRIPTION OF VESSEL’S PARTICULARName of Vessel for Registration / IMO Number / Gross Tonnage (GRT) / Net Tonnage (NRT)
Type of Vessel / Length (M) / Breadth (M) / Depth (M)
Number of Decks / Number of Masts / Number of Funnels / Material of Hull
Vessel’s Previous Name / Vessel’s Previous Nationality* / Deadweight
Year Built / Place Built (City, Country) / Builder’s Name
Radio Equipment
(Radio Telephony, OR, GMDSS) / Sea Trading Area / Entity Responsible for Radio Account(AAIC Name & AAIC Code)
Number of Engine / Type of Engine / Maker of Engine / Model of Engine
Engine’s Year Made / Number of Shaft / Horsepower(KW) / Speed (knots)
* In case of BBC IN registration, pls. indicate vessel’s ORIGINAL flag, instead of vessel’s previous nationality.
DESCRIPTION OF OWNER / CHARTERER* OPERATOR / APPLICANTShip Owner / Charterer *
* In case of BBC IN registration, pls. indicate Charterer instead of Ship owner. / Responsible person of
Ship Owner / Charterer*(in case of BBC IN Registration only)*
Name : / Name :
Position :
Passport No.
Address : / Tel/ Fax No. :
E-mail :
Address :
Actual Company Responsible for Operation
(DOC operator)
Previous Ship Owner / Original Flag’s Ship Owner *
*In case of BBC IN registration, indicate Original Flag’s owner, instead of previous owner / Company name :
Name : / Tel / Fax No.:
E-mail :
Address :
Applicant
Address: / Name :
Position :
Company:
Citizenship:
Passport No.
Tel/Fax No.:
E-mail :
Address :
Intended Date of Registration / Port Where Vessel Is at present / Date & Place of Application (City, Country)
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RADIO INSTALLATIONSEquipment / Manufacturer / Type No. / Power / Emission / Frequency Band
VHF Radiotelephony
VHF/DSC Encoder / Decoder
MF Radiotelephony
MF/DSC Encoder / Decoder
MF/HF Radiotelephony
MF/HF/DSC Encoder / Decoder
Inmarsat SES
Navtex Receiver
EGC Receiver
Satellite EPIRB
VHF EPIRB
Radar Transponder (SART)
Radio Direction Finder
Main Transmitter
Main Receiver
Reserve Transmitter
Reserve Transceiver
Radiotelephony Transceiver
VHF Transceiver
Two-way Radiotelephone VHF
Radar 1
Radar 2
Auto Alarm Apparatus
Automatic Keying Device
Lifeboat VHF
AIS
(Other Equipment if any)
TYPE OF SERVICE / VOYAGE
Vessel Certified for UMS (Unattended Machinery Space Operation) / Type of Service ( √ )
( )
( ) / No
Yes / ( )
( )
( ) / International
Costal
Other : ______
Type of Voyage ( √ )
( )
( ) / Short International Voyage
Unrestricted Voyage
MANNING COMPLEMENT
DECK / ENGINE
Officers / Ratings / Engineers / Ratings
Rank / No. / Rank / No. / Rank / No. / Rank / No.
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Name & Signature of Applicant Name & Signature of Deputy Registrar (DR No.)
FOR OFFICIAL USE ONLYCall Sign / Official No. / MMSI No. / Auth No.
Remark
F-54/Rev.0 International Ship Registry of Cambodia
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