application to approve offshore containers - maritime nz · application to approve offshore...
TRANSCRIPT
Page 1 of 4
Application to approve offshore containers
Last updated: 8 May 2015
About this form
Use this form to apply to approve offshore containers as an approving authority or an authorised organisation in accordance with Maritime Rule Part 24E.
To complete your application you will need:
your completed approval plan
a list of the inspectors who will be completing the approval of offshore containers
Note: You must complete this form correctly for your application to be valid.
Page 2 of 4
1. Applicant details
All applicants must complete this section.
Which type of applicant are you? Approving authority
An authorised organisation or a New Zealand based engineering approval inspection or testing agency approved by the Director for the purposes of Maritime Rule Part 24E.
Authorised organisation
An organisation that has entered into a memorandum of agreement with the Director in compliance with IMO Assembly Resolution A.739(18) and its Annexes, whereby that organisation may verify that the design, construction and testing of an offshore container is in accordance with the requirements of MSC/Circ 860. This may include a Class Society.
Name of organisation Provide the full name of the organisation applying to approve offshore containers.
Name of organisation
Name of legal entity if different from above
Main contact person Give the details of the main contact person within your organisation for this application.
Surname
Given names
Contact numbers Day time phone
After hours phone
Mobile phone
Fax number
Email address
Postal address
Post code
Page 3 of 4
2. Declaration
All applicants must complete this section.
I declare that the details provided on this form are true and correct. I confirm that any other documents sent with this form are true and genuine, and were given and signed by the persons whose names appear on them. (Note: we will only accept certified copies of any supporting documents.)
Caution: providing false information or failing to disclose information relevant to the granting or holding of a maritime document is an offence under section 406 of the Maritime Transport Act. The penalty for this offence in the case of an individual, is imprisonment for a term of up to12 months or a fine of up to NZ$10,000.
Your name
Your signature
Date DD/MM/YYYY
Personal information collected in this form will be used for the purpose of assessing your application. MNZ will not disclose personal information other than when permitted orrequired by law to do so. If you wish to access or correct personal information MNZ hodls about you, please contact the MNZ Privay Officer at PO Box 25620, Wellington 6146, or phone (04) 473 0111.
Page 4 of 4
3. Where to send your application
Send your completed form and the other documents required, to MNZ by email, courier, or post.
Sending your application by email is preferred. Remember to sign the declaration before scanning and attaching it to the email along with any other documents. Make sure the scanned copies of your documents are legible and of a good quality.
Email your application to:
or
Courier your application to:
Operator Certification Maritime New Zealand 1 Grey Street Wellington 6011 or
Post your application to:
Operator Certification Maritime New Zealand PO Box 25620 Wellington 6146