To Navigatein the Northern Sea Route Area (NSRA)

1

Applicationfor Admission

to navigatein the Northern Sea Route Area (NSRA)

(to be sent to the Northern Sea Route Administrationby emailin pdf format)

______№______

(Date,Month,Year)

1.Details of Vessel(s)

№
in order / Vessel(s) name(s) / Type of the vessel
1

2.Applicant status

(tick box)

3.Details of Applicant

3.1 Filled by legal entities only

Full name of organization
IMO number (if available)
Surname,First name,Patronymic (if available) of the Head
Contacttelephone, Fax, E-mail

3.2 Filled by individuals only

Surname, First name, Patronymic (if available) of the Applicant
Contacttelephone, Fax, E-mail

Prior to entering the NSRA the Ship owner undertakes to provide the vessel’s compliance with the Regulations for Navigation in the NSRA

We hereby kindly ask you to permit navigation of the vessel (vessel’s name) in the Area of the Northern Sea Route.

Enclosure(files in pdf format):

1)Vesselandvoyagedetails as per Annex 1to the Regulations for Navigation in the NSRA

2)Copy of Vessel’s Classification Certificate;

3)Copy of Tonnage Certificate;

4)Copies ofdocumentsoninsurance and financial security with regard to the Civil Ability for pollution damage caused by the ship or any other damagecaused by the ship, issued by International Treaties in accordance with the Russian Federation and the Legislation of the Russian Federation(Civil Liability Convention Certificate (CLC),Civil Liability for Bunker Oil Pollution Damage Convention Certificate (CLBC),a certificate of insurance , including risks at the Northern Sea Route).

5)Copy of the Polar Ship Certificate, as provided by the International Code for Ships Operating in Polar Waters (referred to hereinafter as Polar Code) (resolution MSC.385(94) of the Maritime Safety Committee and resolution MEPC.264(68) of the Marine Environment Protection Committee of the International Maritime Organization, the International Convention for the Safety of Life at Sea, 1974, as amended by the Protocol of 1978 and Protocol of 1981) relating thereto), - for ships to which the requirements of the Polar Code apply.

6)Copyof single voyagecertificateissuedbytheorganization responsible for the classification and certification of ships that approved this voyage(only for single voyage vessel navigatingoutside the prescribedarea and seasonrange of navigation).

7)Copyofcertificateissuedbytheorganization responsible for the classification and certification of ships that approved the towing project, (only for towing vessel, including towing of drilling rigs).

8)Copy of the Applicant’s documentof identity(for individuals only).

9)Copyofthedocumentconfirmingtheauthorityofthepersonwho signed the applicationon his own behalforon behalf of theShip owner (for individuals only).

Applicant’s Position / Signature / Full name