655a
From (Applicant name and address)	To
Polski Rejestr Statków S.A. (PRS)
al. Gen. Józefa Hallera 126
80-416 Gdańsk, Poland	Tel. (+48) (58) 346 17 00
Fax (+48) (58) 346 03 92
e-mail: mailbox@prs.pl
www: http://www.prs.pl/
APPLICATION for classification and statutory services
SINGLE CLASS
DOUBLE CLASS
DUAL CLASS
Name of vessel
IMO No.	Call sign	Flag
Date of built	GT	Type
ME/AE [kW]	Present Society	Class Notation
Owner’s name and address	Operator’s name and address
1	The undersigned hereby requests PRS to perform applicable classification surveys and to issue the relevant class documents for the above vessel.

2	The undersigned hereby requests PRS to perform applicable statutory surveys / audits and to issue the statutory certificates on behalf of Administration of (name of state):
relating to the following international conventions / codes:
TONNAGE 1969
SOLAS 1974/78
LL
MARPOL 1973/78
ISPS
AFS
MLC
ISM:	Present DOC issued by	valid until
Types of vessels:	Flags:
3	The undersigned declares the compliance with PRS Rules and Regulations and confirms the knowledge of IMPORTANT NOTES (see overleaf) as well as authorises PRS to obtain from the present Classification Society the classification survey status up to date including any overdue surveys and overdue recommendations or conditions of vessel’s class.

,

Place, date

Name and Signature of fully authorised person
Mutual obligations are to be regulated by a contract or by conditions contained in the Order Confirmation form.
IMPORTANT NOTES

PRS Rules & Publications are available at www.prs.pl.

It is a condition of the class assignment that the applicable surveys mentioned in the Rules for Classification and Construction of Sea-going Ships, Part I, Classification Regulations have been completed with the satisfactory result and that the necessary technical documentation has been provided.

The Temporary Certificate of Class may be issued only after PRS has completed all overdue surveys and all overdue/outstanding recommendations/conditions of class previously issued against the vessel as specified to the Owner by the losing Society. For ships of 15 years of age and over the Temporary Certificate of Class may be issued only after the losing Society has completed all overdue surveys and all overdue/outstanding recommendations/ conditions of class previously issued against the vessel.

The vessel may be accepted into PRS Class under the double or dual class arrangement if there are no overdue surveys or recommendations/conditions by the first Society.

The Owner shall inform the first Society of his request for double or dual class arrangement made to PRS.

Prior to the withdrawal from the class of one of two Societies, the Owner shall inform the Societies of his intended actions when he decides to leave the double or dual class arrangement.

When the Owner is advised that one of the Societies suspends or withdraws class, the Owner shall inform the remaining Society of the action taken by the other Society,

The validity of the Temporary Certificate of Class and the subsequent Certificate of Class is subject to any outstanding recommendations/conditions of class previously issued against the vessel survey being completed by the due date and as specified by the losing/first Society.

If within one month from the receipt of the Survey Status from the losing/first Society, additional recommendations/ conditions of class are submitted to PRS, they shall be dealt with by the due date. Where the Temporary Certificate of Class has already been issued and the received additional recommendations/conditions of class are overdue, they shall be dealt with by PRS in the first port of call or by the losing/first Society, depending on vessel’s age as specified in Note 3, otherwise the Temporary Certificate of Class will be withdrawn with an immediate effect.

The Class will be maintained if all the requirements specified in the Rules for Classification and Construction Sea-going Ships, Part I, Classification Regulations have been fulfilled.

The following plans shall be submitted by the Owner to PRS as a prerequisite of full term classification certificate issuance:

Main plans

General Arrangement Plan

Capacity Plan

Hydrostatic Curves

Loading Manual (where required)

Information on Stability

Information on Damage Stability (where required)

Hull plans

Midship Section

Longitudinal Section

Scantling Plan for bottom, bow and stern

Decks

Shell Expansion

Transverse Bulkheads

Rudder Arrangements

Hatch Covers

Machinery plans

Machinery Arrangement

Fire Control Plan

Intermediate, Thrust and Screw Shafts

Propeller

Main Engines, Propulsion Gears and Clutch Systems (or the manufacturer, type and rating information)

for Steam Turbine Vessels: Main Boilers, Superheaters and Economizers (or the manufacturer, type and rating information) and Steam Piping	Bilge and Ballast Piping Diagram

Wiring Diagram (electric balance of a ship, principle diagram of power distribution circuits and of main and emergency switchboards)

Steering Gear Systems Piping and Arrangements
(the manufacturer and type information)

Torsional Vibration Calculations
(for vessels less than two years old)

Additional plans for vessels with ice strengthening

Plans for flexible couplings or torque limiting shafting devices in the propulsion line shafting
(or the manufacturer, type and rating information)

Additional plans for tankers

Plans of cargo pump-rooms at the forward and after ends and drainage of cofferdams and pump-rooms

General Arrangement Plan of cargo piping in tanks and on decks

Additional plans for vessels with unattended machinery space

Instrument and alarm list

Fire alarm system

List of automatic safety functions

Function testing plan

Additional information

may be necessary according to the Flag State requirements
Where the above mentioned plans are unavailable, PRS is authorized to obtain them from the losing Society.
All losing Society costs (associated with providing PRS with the requested drawings) will be charged to the Owner.

On receiving a request from a Company to take over its ISM and/or ISPS Code certification from another Society (losing Society), an application for such certification can only be accepted by PRS after it has received confirmation (with supporting documentation) that:

the existing certificate has not been withdrawn or otherwise invalidated by the losing Society or the Flag;

all verifications initiated by the losing Society have been satisfactorily completed by the losing Society, unless otherwise agreed between the gaining and losing Societies; and

any major non-conformities have been closed out or down-graded by the losing Society.

As refers to ISM and/or ISPS Code certification see also at www.prs.pl.

All fees and expenses shall be paid in accordance with PRS scale of fees within the dates specified on the invoice form.

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Inspektorat Rozwoju Przepisów

2012-06-12

Polski Rejestr Statków