FORM A

REGISTRATION UNDER PANAMA FLAG

(For all vessels except yachts)

Please proceed to apply for provisional registration the vessel described below and:

1.Request DIGEMAR to instruct Panama Consulate in _______________ to issue the provisional navigation patent and ship station license; or,

2.Have the provisional navigation patent and ship station license issued in Panama City in approximately 2 business days and send them by courier to the following address _________________________

The following are the particulars of the vessel:

VESSEL NAME IN PANAMA: _____________________________________________________________
VESSEL'S NAME IN CURRENT REGISTRY: ________________________________________________________
VESSEL'S IMO VESSELNUMBER:_______________________________________________________
CURRENT REGISTRY:_____________________________________________________________
SHIP OWNER'S NAME:____________________________________________________________
SHIP OWNER'S ADDRESS OUTSIDE OF PANAMA:____________________________________
TYPE OF SERVICE (tanker,bulk carrieretc.):___________________________________________
MATERIAL OF HULL: _____________________________________________________________
NAME OF BUILDERS:________________________________________________________________
PLACE OF CONSTRUCTION:_________________________________________________________
YEAR OF CONSTRUCTION: _________________________________________________________
LENGTH (in meters):_______________________________________________________________
BREADTH (in meters):______________________________________________________________
DEPTH (in meters):________________________________________________________________
GROSS TONNAGE:_________________________________________________________________
NET TONNAGE:__________________________________________________________________
BRAND /NAME OF ENGINE MANUFACTURERS:_________________________________________
NUMBER AND TYPE OF ENGINES:____________________________________________________
NUMBER OF CYLINDER PER ENGINE:______________________________________________
HORSE POWER (in HP, BHP or PS):____________________________________________________
SPEED (in knots):__________________________________________________________________
RECOGNIZED ORGANIZATION:______________________________________________________
RADIO ACCOUNTING AUTHORITY ___________________________________________________

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FORM A