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1、Tel:+886-2-2506-2711FaxNo.:+886-2-2507-4722Website:www.crclass.orgE-Mail:qcd@crclass.org國際安全管理系統(ISM)驗證申請書APPLICATIONFORTHECERTIFICATIONOFASAFETYMANAGEMENTSYSTEM公司名稱NAMEOFCOMPANY:(中英文)指派人員DESIGNATEPERSON:公司識別碼COMPANYIDNUMBER:登記所有人識別碼REGISTEREDOWNERIDNUMBER:地址ADDRESS:連絡

2、人姓名CONTACTPERSON:電話/手機TEL/MOBILE:傳真FAX:電子信箱E-MAIL:申請符合文件(DOC)項目APPLICATIONITEM(S)FORDOC：文件審查DOCUMENTREVIEW公司訪談COMPANYVISIT臨時評鑑INTERIMVERIFICATION初次評鑑INITIALVERIFICATION年度評鑑ANNUALVERIFICATION換證評鑑RENEWALVERIFICATION額外評鑑ADDITIONALVERIFICATION計劃何時接受公司訪談?WhenwillCompanybevi

3、sited?_____________________________________________計劃何時接受評鑑?WhenwillAuditsberequired?__________________________________________________船型ShipType(*此次DOC評鑑包含那幾種船型*ListtypesofshipsofDOCaudit)船名ShipName(每種船型之船名Shipnameofeachtype)申請安全管理證書(SMC)項目APPLICATIONITEMFORSMC：船名SHIP

4、NAME:____________________________________________________(中英文)CR登記號碼CRREGISTERNO.:____________________臨時評鑑INTERIMVERIFICATION換證評鑑RENEWALVERIFICATION初次評鑑INITIALVERIFICATION額外評鑑ADDITIONALVERIFICATION中期評鑑INTERMEDIATEVERIFICATION計劃何時何處接受評鑑?When&wherewillAuditsberequired?地點

5、Place_____________________日期Date_____________________代理行連絡資訊Agencyinformation:_______________________________________________________________________(__________)日期Date申請人簽名Signature職稱PositionFormNo.:XM42/12.2014