Declaration of Company

International Safety Management (ISM) Code

Under the ISM Code, a Company must be declared to the Administration. In accordance with Section 1.1.2 of IMO
Resolution A.741(18), the ISM Code, Company means the Owner of a ship or any other organization or person
such as the Manager, or the Bareboat Charterer, who has assumed the responsibility for operation of the ship from
the Ship owner and who on assuming such responsibility has agreed to take over all the duties and responsibility
imposed by the Code.

The undersigned affirms that:

Name :
Address :
Telephone :
Fax :
E Mail :

is the Owner of the following Ship:

Ship Name IMO Number Flag Port of registry Official Number

In accordance with section 3.1 of Assembly resolution A.741(18), if the entity who is responsible for the operation of
the ship is other than the above stated Owner, the Owner must report the full name and details of such entity to the
Administration.

As such is the case here, the undersigned affirms that:

Name :
Companys Identification No :
Address :
Telephone :
Fax :
E -Mail :

is the Company responsible for all the requirements imposed by the ISM Code for the Ship listed above.

The undersigned further understands that any change in Company must be made in writing to the Administration.

Date of Agreement :

(The Owner) (The Managing Company)
Name / Signature / Stamp Name / Signature / Stamp

Form No.: 1215225 SM10 1/1 Issue.:1/Rev.:01