Enclosure to the Application for Admission to navigate in the Northern Sea Route Area (NSRA)

___________________ ________ (Date, Month, ear)

Details of vessel and voyage !" Details of Shipo#ner !"$ %illed &' entities onl'
%ull name of organi(ation )M* num&er (if availa&le)

Surname, name, patron'mic (if availa&le) of the +ead

,ontact telephone, e-mail, fa.

!"/ %illed &' individuals onl'

Surname, name, patron'mic (if availa&le) of the applicant ,ontact telephone,email,fa.

$" Details of vessel and vo'age

! $ / 0 Name of ship )M* ship identification num&er %lag Ship1s 2all sign

3 6

7 9 : !; !! !$ !/ !0 !3 !6

$ 4ort5 place of departure (last port of call &efore sailing in the #aters of the Northern Sea Route Area) 4ort5 place of destination (first port of call after sailing in the #aters of the Northern Sea Route Area) Description of the planned navigation route (#or8ing area) in the #aters of the Northern Sea Route Area E.pected date of vo'age commence in the Northern Sea Route Area E.pected date of vo'age end in the Northern Sea Route Area 4lanned num&er of cre# on &oard 4lanned num&er of passengers on &oard <'pe of cargo 4lanned =uantit' (metric tons) of cargo Details of to#ed o&>ect ,lass of dangerous cargo (if availa&le) 4lanned =uantit' (metric tons) of dangerous cargo (if availa&le) Ship Master should &e e.perienced in icenavigation in the #aters of the Northern Sea Route Area for at least three month in position of a ,aptain or a ,hief mate" Ship name, )M* num&er and the time periods of navigation in the #aters of the Northern Sea Route Area to &e specified" Ship1s satellite phone num&er (if availa&le)

!7

!9

!:

Ship1s fa. num&er (if availa&le)

$;

Ship1s email address (if availa&le)

$!

<'pe of ship

$$

Ship1s class notation 5 ,lassification societ' ?ength *verAll (?*A) (m) Ma.imum &readth (@eam) (m) Draught (ma.) (m) Aross <onnage Num&er and t'pe of propulsion" 4ropeller shaft(s) po#er (8B) )ce &elt &readth %uel dail' consumption ( for clear #ater full speed ) (metric tons) Cessel1s fore end construction features (presence of &ul&, ramp, etc") Cessel1s aft end construction features

$/ $0 $3 $6 $7

$9 $:

/;

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