Marine pollution prevention — air pollution - Australian Maritime ...

Schedule 1FormsForm MO—97/3Marine Orders, Part 97 (Marine Pollution Prevention — Air Pollution)Local Fuel Oil Suppliers* Annual DeclarationPlease complete this form to verify the information held by the Australian MaritimeSafety Authority’s Local Fuel Oil Suppliers Register and return by mail or fax (by 1month after date of dispatch) to:Manager, Marine Environment StandardsGPO Box 2181Canberra ACT 2601, AustraliaFax: +61 2 6279 50261 Name of Company2 Street Address3 Postal Address4 Contact Name5 Telephone Number6 Fax Number7 Email address8 Fuel Oil Supplier **9 Ports supplied10 Method of delivery11 Type of fuel suppliedThe Register shows:Please enter any correctionsSignature: ______________________________ Date: __________Name & Position: ___________________________________________* The Local Fuel Oil Supplier is the person or company responsible for deliveringthe bunkers to the ship or installation by barge, offshore supply vessel, roadtanker or direct from shore.** The Fuel Oil Supplier is the person responsible for the final blend of fueldelivered to the ship. In some cases the Fuel Oil Supplier will also deliver thefuel to the ship, taking on the additional responsibilities and obligations of theLocal Fuel Oil Supplier.20 Marine Order 97 (Marine pollution prevention — air pollution) 2007MO97 modcomp-130613Z.docx