ABS Marine Casualty Response, Inc. - ABS Consulting

ABS Marine Casualty Response, Inc.
Rapid Response Damage Assessment (RRDA): Enrollment Request Form
Information to be used in preparing or modifying an agreement.
If you need to enroll a ship, please complete the following form and email it to rrda@absconsulting.com.
1. Vessel’s Management Information
Company Name: __________________________________________________________________
Contact Person: ____________________________________________________________
Contact Person’s Title: _______________________________________________________
Address: _________________________________________________________________
_________________________________________________________________
City: _____________________________________ State: ___________________________
ZIP/Mail Code: ___________________ Country: ____________________________________
Telephone Number: _______________________ Fax Number: _____________________
Emergency / 24-hour Number: ______________________
E-mail: ___________________________________ Web site (if available): ____________________
Is billing information the same as above? Yes ____ No ____
If no, please fill in the billing information below.
2. Billing Information
Company Name: ___________________________________________________________
Attention: _________________________________________________________________
Address: _________________________________________________________________
_________________________________________________________________
City: _____________________________________ State: ______________________________
ZIP/Mail Code: ___________________ Country: _________________________________________
If ABS WCN (World Client Number) is known, please provide it. ______________
Please specify any special billing instructions.
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
ABS Plaza, 16855 Northchase Drive, Houston, TX 77060-6008 USA
Tel: 1-281-877-6405 Fax: 1-281-877- 5964 E-mail: rrda@absconsulting.com
RRDA_Form.doc– TMZ-309-01-P01-W002 Rev. 1

ABS Marine Casualty Response, Inc.
3. Vessel Information (please make copies if you are applying for multiple vessels)
Vessel Name: _____________________________________________________________
Registered Owner*: _______________________________________________________
Classification Society: _______________ Class / ID #: ___________________________
IMO Number: ______________________ Flag: _____________________________
Year of Build: _______________
Shipyard: ____________________________
Hull Number: ______________________
Type**: __________________________________
Deadweight (MT): ________________
Breadth (m): _____________________
Length between Perpendiculars (m): _____________
Depth (m): _____________
Sat phone: _______________________, _______________________, _______________________
Sat fax: __________________________ Vessel E-mail: _____________________________
* The registered owner will be defined as the client in the ABS RRDA Agreement.
**Types: 1) Oil tanker: 2) Product tanker 3) Chemical Tanker ( IBC Code type 1 and 2 ); 4) Tug, Fishing vessel, Yacht ; under 65m or over
65m; 5) Offshore supply vessel under or over 65m; 6) Special purpose vessel; 7) LNG/LPG with prismatic tanks; 8) LNG/LPG with spherical
tanks; 9) General cargo vessel; 10) Bulk carrier/ OBO; 11) Vehicle carrier; 12) Container vessel; 13) Ferry; 14) Passenger;15) FPSO/FSO;
16) Self elevating, Semi-sub, TLP, Spar 17) Barge
Note: If this is a sister vessel to a vessel already enrolled, please identify the following:
Shipyard: _____________________________________ Hull Number: __________________________
Vessel Name: _________________________________ IMO Number: __________________________
Please provide any additional notes:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
ON BEHALF OF THE CLIENT
Signed
Name: __________________________________
Title:____________________________________
Date Signed:
______________________________________
ABS Plaza, 16855 Northchase Drive, Houston, TX 77060-6008 USA
Tel: 1-281-877-6405 Fax: 1-281-877- 5964 E-mail: rrda@absconsulting.com
RRDA_Form.doc– TMZ-309-01-P01-W002 Rev. 1