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Republic of the Philippines

Department of Transportation
MARITIME INDUSTRY AUTHORITY
MARINA Regional Office No. VIII

The Regional Director


MARITIME INDUSTRY AUTHORITY
MARINA R.O. No. VIII
Tacloban City

Sir/ Madam:

This is to respectfully request your Office for the survey of the vessel described hereunder for the
issuance of the following:

Authority to Construct Approval of Ship's Plan/Sketch Plan


Construction Certificate Tonnage Measurement Certificate (TMC)

VESSEL PARTICULARS
Classes of Vessel: (Pursuant to Reg. I/5, PMMRR 1997)
Passenger Cargo Fishing Other:_________________

A. Clearance Name of Vessel:


Principal Name of Vessel : 1st Alternate Name of Vessel : 2nd Alternate Name of Vessel :

Vessel Owner/ Operator Business Address: TIN :

Gross tonnage (Approx.): Net Toonage (Approx) : Reg. Length: Reg. Breadth: Reg. Depth: Hull Material:

Type of STEM: Type of STERN: No. of Deck: No. of Mast No. of Kingpost: No. of Outriggers

Main Engine Make: BHP/KW: No. of Enigne: No. of Cylinder: No. of Cycle: Engine Serial Nos.

BOATBUILDER INFORMATION
Name of Builder Validity: Registration Number:

Place Constructed: Date Constructed:

B. Placed and Schedule of Survey:

Date of Survey Place of Survey


Confirmed by:

(Signature Over Printed Name of Assigned Surveyor) (Date of Confirmed)


NOTES:
- This application will be received only upon confirmation of the schedule of Survey by assigned Surveyor, payment of processing/survey
fees and submission of the documentary requirements listed at the back portion of this form;
- Authorized representative must have Special Power of Atorney/ Board Resolution; and
- Processing time - Eight (8) working days from date of survey.

This is to certify that the undersigned is authorized to file this application before the Maritime
Industry Authority (MARINA) and the above-mentioned information are true and correct to the best of my
knowledge.

(Signature Over Printed Name of Owner/Representative) Date of Application

Screened/ Evaluated by:


1. Application for Authority to Construct/ Approval of Vessel/Skeleton Plan/
Construction Certificate/ Tonnage Measurement Certificate (TMC)

1.1 Application Form/Letter duly signed by applicant;


1.2 Duly signed Boatbuilding Contract;
1.3 Approved Ships/Skeleton Plan & Accommodation Plan (for passenger)
(for vessel 15 GT and above);
1.4 Vessel Sketch Plan (for vessel 15 GT below);
1.5 Affidavit on source of woods/logs;
1.6 Certification on the availability of area/yard from Barangay, and
1.7 Name Clearance of Vessel
1.8 Duly Notarized Affidavit of Ownership
1.9 Duly Notarized Builder Certificate
1.10 DTI Registration for single proprietorship
1.11 SEC registration
1.12 Notarize Board Resolution /Secretary's Certificate authorizing the filling
of application and designating the person to represent the company
1.13 CDA Certificate of Accreditation (for Cooperatives)
1.14 Ship/ Boat Pictures (5 in. x 7 in.) size
1.15 Purchase Receipt of Engine (Barangay Certification in lieu of purchase
Receipt);

Fees and Charges for the following applications:


1.16 Application-Authority
- to Construct P 500.00
1.17 Application for Approval of Vessel/Skeleton Plan and Accommodation
(for passenger) - (@ P 160.00 per section) - P ________________
1.18 Application for Construction Certificate - - P 470.00
1.19 Application for issuance of Tonnage Measurement Certificate (TMC)
3 GT and below - 700
Above 3 – 15 GT below 800.00
15 GT – 35 GT below 950.00
35 GT – 100 GT below 1,750.00
1.2 Application for Name Clearance of Vessel 80

NOTE: IF THE APPLICATION IS APPLIED DURING MIBLE REGISTRATION THE FEES ONLY P
750.00 - Covered all fees