1 Applicant Details Cayman Islands Shipping Registry HEAD OFFICE 133 Elgin Avenue P.O. Box 2256 Grand Cayman KY1-1107 Cayman Islands Tel: +1 345 949 8831 Fax: +1 345 949 8849 Email: registration@cishipping.com Website: www.cishipping.com Name of Owner/Demise Charterer: Physical Mailing Contact Person 1: Telephone: Fax: Contact Person 2: Email: Unique Registered Owner Identification Number: Type of Registration Service(s) Required PLEASE CHECK ALL THAT APPLY Full Registration - Pleasure Full Registration - Commercial Full Registration - Local Fishing Vessel Transfer of Ownership Transmission of Ownership Vessel Under Construction Transfer of Port to the Port of George Town Transfer of Port to the Port of The Creek Transfer of Port to the Port of Bloody Bay Demise Charter-In to the Port of George Town Demise Charter-In to the Port of The Creek Demise Charter-In to the Port of Bloody Bay Interim Registration Representative/Authorised Person: Signature: Capacity: Date (DD/MM/YYYY): Page 1 of 7
2a Vessel Details Proposed Name of Vessel * : Select Choice of Ports 2 : George Town Current Registered Name of Vessel : Current Port of Registry: George Town The Creek The Creek Bloody Bay Bloody Bay Official Number : IMO Number (if applicable): Date of Construction (DD/MM/YYYY): Method of Propulsion: Sail Non-Propelled Steam Motor - Total Propulsion Engine (KW): Type of Ship: Tonnage: GROSS NET Measurements (metric units, as specified in ship s Tonnage Certificate or Certificate of Survey) : Length (M): Breadth (M): Moulded Depth (M): * On a separate sheet, list in order of preference any additional names. 2b Declaration of Ownership or Eligibility on Behalf of a Company/Body Corporate NOTE: Declarations must be made before the Registrar of Shipping or other authorised officer of the Cayman Islands Shipping Registry, a Justice of the Peace, a Commissioner for Oaths within the meaning of the Cayman Islands Oaths Law, a Notary Public, a British Consular Officer, or other persons with a professional qualification at the discretion of the Registrar. The qualification of the person making the declaration and the place of attestation are to be added to his/her signature. UPON COMPLETION OF SECTION 2B, GO TO SECTION 3 The Company/Body Corporate Declaration I: Declare as follows; The said company was incorporated by virtue of 3 : on the (DD): Year (YYYY): and is subject to the laws of 4 : The said company has its registered office at: and a place of business at: where meetings of the Directors of the Company are regularly held. The said company is registered as a foreign company in the Cayman Islands with an address at 5 : The aforementioned general description of the ship is correct. The said company/body corporate is eligible to be registered as Owner of Page 2 of 7
To the best of my knowledge and belief, a majority interest in the said ship will at the time of registration be owned by a body corporate who is qualified to own Cayman Islands ships under the relevant provisions of the Cayman Islands Merchant Shipping Law, as amended. I make this solemn Declaration conscientiously believing the same to be true. 2c Declaration of Ownership or Eligibility on Behalf of an Individual UPON COMPLETION OF SECTION 2C, GO TO SECTION 3 Individual Declaration I: Declare as follows: The above described ship was built at: The aforementioned general description of the ship is correct. I am eligible to be registered as Owner of in the year (YYYY): To the best of my knowledge and belief, a majority interest in the said ship will at the time of registration be owned by a person who is qualified to be the owner of a Cayman Islands ship under the relevant provisions of the Cayman Islands Merchant Shipping Law, as amended. I make this solemn Declaration conscientiously believing the same to be true. Declaration/Date commission expires (DD/MM/YYYY): Page 3 of 7
2d Declaration of Ownership or Eligibility on Behalf of Joint Owners UPON COMPLETION OF SECTION 2D, GO TO SECTION 3 Joint Ownership Declaration 1 Name (IN FULL) *: 2 Name (IN FULL) *: 3 Name (IN FULL) *: 4 Name (IN FULL) *: * If Joint Owners exceed space provided, please provide additional information on another sheet. We: Declare as follows: The above described ship was built at: The aforementioned general description of the ship is correct. We are eligible to be registered as Joint Owners of in the year (YYYY): To the best of my knowledge and belief, a majority interest in the said ship will at the time of registration be owned by persons who are qualified to be the owners of a Cayman Islands ship under the relevant provisions of the Cayman Islands Merchant Shipping Law, as amended. We make this solemn Declaration conscientiously believing the same to be true. (PRINT NAME OF SIGNATORY): (PRINT NAME OF SIGNATORY): (PRINT NAME OF SIGNATORY): Declaration/Date commission expires (DD/MM/YYYY): Page 4 of 7
2e Declaration of Ownership or Eligibility on Behalf of a Partnership UPON COMPLETION OF SECTION 2E, GO TO SECTION 3 The Limited Liability/Exempted Limited Partnership Declaration I: Declare as follows; The said partnership was registered by virtue of 3 : on the (DD): Year (YYYY): and is subject to the laws of 4 : The said partnership has its registered office at: and a place of business at: where meetings of the General Partners of the Partnership are regularly held. The aforementioned general description of the ship is correct. The said partnership is eligible to be registered as Owner of To the best of my knowledge and belief, a majority interest in the said ship will at the time of registration be owned by a body of persons who is qualified to be the owner of Cayman Islands ships under the relevant provisions of the Cayman Islands Merchant Shipping Law, as amended. I make this solemn Declaration conscientiously believing the same to be true. 1 Insert the Official Number if allocated by the Cayman Islands or if the Vessel is currently registered with another Red Ensign flag. 2 For merchant vessels, only the Port of George Town can be uesed. 3 Insert the name of the statutory provision pursuant to which the company was incorporated/partnership registered (including the name of the country pursuant to whose law such statutory provisions was made). 4 The Cayman Islands or as the case may be. 5 If applicable. Page 5 of 7
3 Appointment of a Cayman Representative Person I hereby confirm the appointment of a Cayman Representative Person for the above described vessel as follows: Name of Individual or Body Corporate to act as a Cayman Representative Person: Physical Mailing Telephone: Name: Fax: Email: Owner s/authorised Person s Signature: Capacity: Date (DD/MM/YYYY): 4 Undertaking to Act as a Cayman Representative Person I acknowledge that the duties of a Cayman Representative Person include: Knowledge of the Beneficial Owner and attaching due diligence to the same degree as though he or she were screening a client or company registered in the Cayman Islands in accordance with the Laws or codes of practice applicable to the local professional associations. An obligation to remain a Cayman Representative Person until such time as a replacement is appointed and accepted as prescribed under the law. An obligation to abide by such directives as may be prescribed from time to time by the Chief Executive Officer of the Maritime Authority of the Cayman Islands. I hereby accept the appointment of a Cayman Representative Person for the described vessel (as per Section 3) as follows: Name of Individual or Body Corporate to act as a Cayman Representative Person: Physical Mailing Telephone: Name: Fax: Email: Representative/Authorised Signatory or Body Corporate: Capacity: Date (DD/MM/YYYY): Page 6 of 7
5 Declaration and Undertakings i Private Use Owner(s)/Authorised Person(s) declare that the above vessel is for private use and will not be engaged in trade. Further, it is also declared that should the vessel be chartered, this will only be for private use under a written charter party agreement. The number of persons carried onboard to sea, in addition to crew, will never exceed twelve (12). ii Carving & Marking Owner(s)/Authorised Person(s) undertake to have the above named vessel marked with its Port of Registry, Official Number, Net or Registered Tonnage and IMO Number (if applicable), within 21 days in accordance with the relevant provisions of the Merchant Shipping Law, as amended, or before the vessel proceeds to sea, whichever is sooner. iii Original Documents Owner(s)/Authorised Person(s) undertake to have the original title-related documents (i.e. Builder s Certificate, Bill of Sale, and Mortgage Deed) submitted to the Cayman Islands Shipping Registry for stamping within 7 days of the date of service. iv Bill of Sale and Declaration of Ownership (Interim Registration) Owner(s)/Authorised Person(s) undertake to submit the original Bill of Sale and Declaration of Ownership or Eligibility for the above named vessel to the Cayman Islands Shipping Registry within 21 days of the issue date of the Interim Certificate of Registry. 6 Supporting Documents Enclosed (Registration - All Vessels) The following documents have been included (where applicable) with this application in accordance with the prescribed requirements of the Cayman Islands Shipping Registry. PLEASE CHECK ALL THAT HAVE BEEN INCLUDED Bill of Sale Transferee s Declaration Transcript of Register Tonnage Certificate Court Order Declaration of Transmission Shipyard Letter Certificate of Good Standing Certificate of Survey Owner s/mortgagee s Consent Construction Contract Other (PLEASE SPECIFY) Builder s Certificate Certificate of Registry Deletion Certificate Charter Party Agreement Resolution to Sell Page 7 of 7