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LTO Application Form New

The document is an application form for a License to Operate (LTO) certificate from the Maritime and Port Authority of Brunei Darussalam. It requires information such as applicant details, ship details, proposed inspection schedule, supporting documents, and a declaration signed by the applicant. A complete application with applicable fee must be submitted at least 14 days before the proposed inspection date. Required supporting documents and guidelines can be found on the MPABD website.

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190 views6 pages

LTO Application Form New

The document is an application form for a License to Operate (LTO) certificate from the Maritime and Port Authority of Brunei Darussalam. It requires information such as applicant details, ship details, proposed inspection schedule, supporting documents, and a declaration signed by the applicant. A complete application with applicable fee must be submitted at least 14 days before the proposed inspection date. Required supporting documents and guidelines can be found on the MPABD website.

Uploaded by

ridlwan.fos
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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MPA006-2/17

LICENSE TO OPERATE (VESSEL) APPLICATION


• An application for a License to Operate Certificate must be submitted to Maritime and Port Authority of Brunei Darussalam no
less than 14 days prior to the proposed inspection date.
• The application form, supporting documents and applicable fee must be submitted to Survey Section, MPABD Office.
• List of supporting documents and guideline on application of A license To Operate may be downloaded from
www.mpabd.gov.bn

NEW
Application type : RENEWAL EXTENSION
APPLICATION
Existing LTO certificate no
:
(if renewal/ extension)

Applicant Detail

Name of local Representative Company Company Registration No.

Business address

Focal Person Office No. Handphone No.

Designated Person Ashore Office No. Handphone No.

Shipping Agent Company & (state focal person) Office No. Handphone No.

Purpose of LTO application

Duration of the LTO applied for: One month

Proposed date of commencement:


Ship detail

Name of Shipowner

Ship’s name Callsign IMO/ Official No Flag

Ship’s type Year of built Gross Registered Tonnage

Length Breadth Depth Type of engine Engine Power (kW)

Proposed Inspection Schedule

Location of inspection :
:
First proposed inspection date :

Second proposed inspection date :

Applicant’s declaration

I/We declare that I/we have read all the answer I/we have given to the questions in this application and
that the answers given by me/us are complete, true and correct in every detail.

I/We understand that I/we may be prosecuted for giving or stating any false misleading information and
that penalties apply.

I/We agree to arrange for the craft to be inspected the MPABD’s inspector as soon as this application is
approved (or as and when required) to abide by all the conditions as imposed by the
Director of Marine.

I/We agree that the Surveyors’ expenses including all travelling expenses, insurance, taxation, and all
boards and lodging expenses will be borne by our company.

Signature of the Applicant Date


Name:
DETAIL OF CERTIFICATES AND DOCUMENTS

Certificate/ Date of issue Last Issued by / certificate


NO Expiry date
Document endorsement No.
1 Registry Certificate

2 Class Certificate

Safety Construction
3
Certificate (500GT)

Exemption

Load Line
4
Certificate (24m)
Load line exemption
5
certificate
Freeboard
Assignment report
Safety Equipment
6
Certificate

Form E

Exemption
Certificate
International
7
Tonnage Certificate
Safety Radio
8
Certificate (500GT)

Form R

Exemption
Certificate
Cargo ship Safety
9 Certificate (less
than 500gt)
Radio Station
10
License
IOPP Certificate
11
(400GT)

Supplement
International Air
12 Pollution Prevention
Certificate (400GT)
Supplement
Engine IAPPC
13
Certificate
International Energy
14 Efficiency Certificate
(400GT)
Supplement
International
Sewage Pollution
Prevention
15
Certificate (400gt or
carrying more than
15 persons)
International Ballast
16 water management
certificate
ISM Document of
17
Compliance (DOC)
Safety Management
18
Certificate (SMC)
International Ship
19 Security Certificate
(500GT)
Continuous
Synopsis Record
(500 GT)
MLC Certificate
20
(500GT)

DMLC Part 1

DMLC Part 2

Safe Manning
21
Certificate
International Anti
22 fouling Certificate
(≥400GT)
Record of Anti-
Fouling System
Declaration of anti
fouling system
(≥24m less than
400GT)
Certificate of
23
Fitness for HNS
Compliance
24
Certificate for
Carrying Dangerous
Goods
Ship Sanitation /
25 exemption
Certificate
Insurance Coverage (
26 P& I)
Insurance Coverage
( H&M)
CLC for wreck
removal (300GT)
CLC for bunker oil
pollution certificate
(1000GT and
above)
MLC Certificate of
insurance
shipowners’ liability
MLC Certificate of
insurance seafarer
repatriations
27 MODU certificate

Passenger Ship
28
Safety Certificate

Exemption

Non-mandatory
certificates
Special Purpose
29
Ship Certificate
Offshore Support
30 vessels Document
of Compliance
Certificate of
31 Fitness for Offshore
Support vessels
Diving System
32
Safety Certificate
Safety Compliance
Certificate for
33
Passenger
Submersible Craft
Dynamically
34
Supported craft
Mobile offshore
35
drilling units
Wing-in-ground
36
safety certificate
Permit to operate
37
WIG Craft

Note: If non-applicable, column should be indicated by N/A

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