SERVICE REQUEST FORM FOR COMPLIANCE WITH

MARPOL ANNEX VI CHAPTER 4

To: Indian Register of Shipping

We hereby request your services to be carried out for compliance towards MARPOL ANNEX VI
CHAPTER 4 (Please select from Table 1 on Page 2)

This request is being made in the event of:

Entry into force of new requirement for existing ships
Change of Flag Change of Company Change of Flag & Company
Change of Verifier
Major Modification (Specify) ______________________________________________________________________

Company Details

Company Name (Name of DOC holder) TW Ship Management Private Limited

Address of Company

Phone Number

Contact Person (s) in the company Name: Kabilan Sadasivam

Designation: Asst. General Manager -Technical
Email ID: Kabilan.Sadasivam@transworld.Com
Telephone Number:
Mobile Number: 9489972232
Details required for Invoice Name (As printed on PAN):
Address:
PAN No:
TAN No:
GST No:

Details of ships: (Additional sheets may be attached if necessary)

Sr. Ship Name IMO No. / IR No. Ship Type 1

No
1 SSL VISAKHAPATNAM 9137521 / 47618 CONTAINER SHIP
2
3
4
5
6
7
8
9
10
Note 1: As defined in regulation 2 of MARPOL Annex VI. If any other ship type, same to be stated.

Form No: SRF_MARPOL Annex VI Chapter 4_Rev.0 Page 1 of 3