The following 16 numbered information items, with the data entered for each item in the right-hand column:
(1) This document applies from (date); (2) Flag State; (3) Date of registration with the State indicated in (2); (4) Name of ship; (5) Port of registration; (6) Name of current registered owner(s) and Registered address(es); (7) Registered owner identification number; (8) If applicable, name of current registered bareboat charterer(s) and registered address(es); (9) Name of Company (International Safety Management); Registered address(es); Address(es) of its safety management activities; (10) Company identification number; (11) Name of all classification societies with which the ship is classed; (12) Administration/ Government/ Recognized Organization which issued Document of Compliance; Body which carried out audit (if different); (13) Administration/ Government/ Recognized Organization which issued Safety Management Certificate; Body which carried out audit (if different); (14) Administration/ Government/ Recognized Security Organization which issued International Ship Security Certificate; Body which carried out verification (if different); (15) Date on which the ship ceased to be registered with the State indicated in (2); (16) Remarks (Insert relevant information as Appropriate).
