PANAMA MARITIME AUTHORITY

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PANAMA MARITIME AUTHORITY

Technical Office


Segumar Panama

Pan
-
Canal Building, Omar

Torrijos Herrera Ave.

4th Floor, Albrook; Panama City, Panama






APPLICATION FOR MOBILE OFFSHORE DRILLING UNIT (MODU)

MINIMUN SAFE MANNING

CERTIFICATE

………………………………………………………………………………………………………………………
.......

Name of Applicant
:







Address:







Phone:







Fax:







Email:







…………………………………………………………………………………………………………………………
...


GENERAL INFORMATION

Name of M
O
DU
:







Registration
No.







Call Letter:







IMO No.:







Year

of built:







Existing Unit




New Unit

ITC 69 Gross
Tonnage:







Net Tonnage:







Vessel classified with GMDSS





YES


NO


Non
-
Self Propelled

IF

Self Propelled


Main Engine’s Power (HP or Kw):







H
as there been a MSM for this M
O
DU
?

NO



IF

YES





MSMC No.:










Previous ITC:







…………………………………………………………………………………………………………………………...

TYPE OF MODU



Surface Units






Bottom
-
Supported

Drilling Rigs





1.

Semi
-
Submersible or Colum stabilized unit


1.
Submersible

2.

Drill ships




2.

Self
-
Elevating (Jack
-
Up
)




………………………………………………………………………………………………

OPERATION MODES

ON LOCATION

(check one of the following)

TRANSIT CONDITION (underway)

(check one of the following)


Floating




Moored with anchors


Underway 16 Hrs. or less in any 24 Hrs. periods






Dynamically

positioned


Underway 17 to 72 Hrs.




Underway 72 Hrs. or less


Bottom Bearing


Underway more than 72 Hrs.



Moveable legs


Under Tow


Others


.......................................................................................................................
.....................................
..............

PRESENT MANNING

ON BOARD

(
) Offshore Installation Manager

(
) Master

(
) Chief Engineer

(
) Barge Supervisor

(
) Chief Officer

(
) First Engineer

(


) Ballast Control Operator

(


) Deck Officer

(


) Engineer Officer

(


) A.B. Seaman

(


) A.B. Seaman

(


) Oiler(s)
/ Motormen

(


) O. Seaman

(


) O. Seaman

(


) Certifi
cated Person

(


) Certifi
cated

Person

(


) Certificated

Person

(


) Radio Officer


Enclosed you will find check for
amount of U.S. $ 150.00 Payable to
“PANAMA MARITIME AUTHORITY”

Tel: (507) 501
-
5361/62

Fax: (507) 501
-
5363/64


E
-
mail:
msm@segumar.com