APPLICATION FOR MARITIME LABOUR

EXEMPTION CERTIFICATE
(***Incomplete applications will be declined***)

Vessel Name:       IMO No. :      

Type of Vessel:       Call Letters:      
Year Keel was Laid:       Gross Tonnage:      

Operator Name:      

Operator Address:      
Tel & Fax:      

Name of Company responsible for receiving original documents and paying for invoices (if
different from Operators):
     

Exemption request (According to Title 3, Regulation 3.1, Standard A3.1):

     

Name of Class Society/ Recognized Organization responsible for the issuance of the Maritime
Labour Certificate:
     

Special Conditions (if any):

     

SEG-MLC-1 Page 1 / 1
Rev. March 2021