Exemption, Extension, Equivalent, Dispensation Application Form

Exemption, Extension, Equivalent, Dispensation Application

This form must be completed for all applications for exemptions, extensions, equivalents and dispensations under an applicable international convention or mandatory code, except for dispensations under the STCW Convention. For STCW dispensations, please use the STCW Dispensation Application Form

Vessel Details

Vessel Name

Type of vessel

IMO Number

LL Length(m)

Gross Tonnage

Class

Application Type

Company Details

Company Name

Company IMO Number

Survey Details

Number LL of

Type of Survey

Place of Survey

Details of Exemption, Extension, Dispensation, Equivalent Request

Convention

Please enter the name of the international convention or mandatory code under which the application is being made. Exemption Example: SOLAS 1974, as amended.

Regulation to be exempted, dispensated from, or extension or equivalent be granted for

Please identify the specific regulation of the applicable convention or code that authorises the Administration to grant the exemption, extension, dispensation or equivalent being requested.

Exemption Example: Chapter I, Regulation 4 – Exemptions.
Equivalent Example: Chapter I, Regulation 5

Reasons

Supporting Documentation

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

Please upload your supporting documentation here. pdf, jpg, jpeg and png files accepted with a maximum file size of 5Mb each.

Details of Applicant

Full Name of Applicant

Title of Applicant

Email Address

Exemption, Extension, Equivalent, Dispensation Application Form