Of the Shipowner to the Monitoring and Security Alert Center

Addendum № 1 to the Agreement № ______

APPLICATION FORM * OF THE SHIPOWNER TO THE MONITORING AND SECURITY ALERT CENTER FOR REGISTRATION IN THE SHIP SECURITY ALERT SYSTEM

1. COMPANY (Full name of your company, including the form of property and the established abbreviated name of the organization)

2. POST ADDRESS (Building, house, street, city or any place of residence, region, index, country)

3. TELEPHONE, FAX, TELEX, E-MAIL (including the country and the city codes for phone and fax; including the country code for telex) Telephone: Fax: Telex: E-mail:

4. NAME, PATRONYMIC, SURNAME AND THE CONTACT DETAILS OF THE OFFICIALS RESPONSIBLE FOR CONNECTION WITH THE MONITORING AND SECURITY ALERT CENTER IN CASE THERE IS THE SHIP SECURITY THREAT (The test SSAS messages about the ship security threat got from the ships will be automatically sent to the e-mail addresses indicated in this point)

Officer on duty (24 hours): Telephone 1: Telephone 2: Fax: E-mail:

Names of the Company Security Officers: Name: Telephone: Mobile phone: Fax: E-mail:

Surname, Name: Telephone: Mobile phone: Fax: E-mail:

Names of the Officers responsible for satellite communication: Name: Telephone: Mobile phone: Fax: E-mail:

* You may find the registration form in http://www.marsat.ru/files/vic_reg_ssas.doc. Please fill it in and send by e-mail to [email protected] or by fax +7 (495) 967-18-82. In case you have any questions about how to register a ship in the Ship Security Alert System do not hesitate to get in touch with Marina Fedorova (phone +7 (495) 967-18-82). In case the question is about how to test the SSAS equipment please contact Pavel Sokolov (phone +7 (495) 795-32-29). 5. INFORMATION ABOUT THE VESSEL/VESSELS TO BE REGISTERED IN THE SSAS**:

5.1. Vessel’s Name (in Latin): 5.2. Vessel’s flag:

5.3. Port of registry: 5.4. Vessel’s type:

5.5. Call Sign (Latin): 5.6. IMO Number:

5.7. Russian Maritime Register of Shipping identification number (if exists):

5.8. Russian River Register identification number (if exists):

5.9. Maritime mobile service identity (MMSI):

Information about the SSAS equipment based on Inmarsat-C or Inmarsat Mini-C mobile stations (underline your type)

5.10. Model of the SSAS: (quoted from the RMRS or the Rissian Ministry of Transport Type Approval Certificate) 5.11. Built-in GPS-receiver of the Inmarsat-C [ ] the Inmarsat-C or Inmarsat-Mini-C station has the built-in GPS or Inmarsat Mini-C station: [ ] the navigational data are got from the outside source

5.12. Serial number of the CCOO-1 interface unit: (only for Inmarsat Mini-C) Serial number of the CCOO-2C controller: (only for Inmarsat-C)

5.13. Inmarsat-C/Inmarsat Mini-C software version of the mobile station (DCE ver.):

5.14. [ ] the Inmarsat-C / Inmarsat-Mini-C station is used only to transfer messages about the ship security threat [ ] Beside the messages about the ship security threat the Inmarsat-C / Inmarsat-Mini-C station is used for:

(indicate the additional purpose) 5.15. Serial number of Inmarsat-C/Inmarsat Mini-C station: (the ISN number is indicated in the Inmarsat-C/Inmarsat Mini- C station body or in the documents) 5.16. The mobile number of the Inmarsat-C/Inmarsat Mini-C station: (the telex number of the Inmarsat-C/Inmarsat Mini-C station)

Information about the SSAS equipment based on Inmarsat D+

5.17. Model of the SSAS: (quoted from the RMRS or the Rissian Ministry of Transport Type Approval Certificate) 5.18. Serial number of the SSAS: (the serial number is indicated in the main unit body and in its passport) 5.19. Inmarsat D+ ISN number: (the ISN Inmarsat D+ number is indicated in the main unit body and in its passport. The ISN number has the initial letters DST…)

On behalf of the Company:

(Title)

(Signature, Name )

** If you wish to register more than one ship, copy the point 5 and fill it in separately for each ship. If you wish to install SSAS based on Inmarsat-C or Mini-C station you need to fill in the points from 5.10 to 5.16, and if you wish to install SSAS based on Inmarsat D+ station you need to fill in the points from 5.17 to 5.19. «___»______200 __ .