Appendix – Model Form of Minimum Safe Manning Document
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Statutory Documents - IMO Publications and Documents - Resolutions - Assembly - IMO Resolution A.1047(27) – Principles of Minimum Safe Manning – (Adopted on 30 November 2011) - Annex 4 – Guidance on Contents and Model Form of Minimum Safe Manning Document - Appendix – Model Form of Minimum Safe Manning Document

Appendix – Model Form of Minimum Safe Manning Document

MINIMUM SAFE MANNING DOCUMENT
(Official seal)     (State)
       
Issued under the provisions of regulation V/14 of the
INTERNATIONAL CONVENTION FOR THE SAFETY OF LIFE AT SEA, 1974, as amended
       
under the authority of the Government of
       
(Name of the State)
by      
(Administration)
       
Particulars of shipfootnote
Name of ship ..................................................................................................................................
Distinctive number or letters ...........................................................................................................
IMO number ...................................................................................................................................
Port of registry ................................................................................................................................
Gross tonnage:
  National .......................................................................................................................................
  International Tonnage Convention, 1969 ....................................................................................
Main propulsion power (kW) ...........................................................................................................
Type of ship ....................................................................................................................................
       
Periodically unattended machinery space yes/no
       
Operating Company
  ............................................................................................................................
Trading areafootnote
       
       
       
The ship named in this document is considered to be safely manned if, when it proceeds to sea, it carries not less than the number and grades/capacities of personnel specified in the table(s) below.
       
Grade/capacity Certificate (STCW regulation) Number of persons
     
     
     
     
       
Special requirements or conditions, if any:
       
Issued at ............................... on the .................... day of ...............................................
      (month and year)
       
Date of expiry (if any) .....................................................................................................................
(Seal of the Administration)
       
    ..........................................................................
    (Signature for and on behalf of the Administration)
Parent topic: Annex 4 – Guidance on Contents and Model Form of Minimum Safe Manning Document
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