连续概要记录格式

表格1

《连续概要记录》文件编号：1

（船名），IMO 编号：

日期格式为年/月/日

	信息
1	本文件适用起始日期：	2004/07/01
2	船旗国：
3	在该国的船舶登记日期：
4	船名：
5	船籍港：
6	船舶所有人：登记地址：
7	光船承租人：登记地址：
8	《国际安全管理规则》所定义的公司名称：登记地址：开展安全管理活动的地址：
9	船舶所入级的所有船级社的名称：
10	向经营该船的公司签发《符合证明》（或《临时符合证明》）的主管机关的名称：
11	向船舶签发《安全管理证书》的认可组织的名称：
12	向船舶签发《国际船舶保安证书》或《临时国际船舶保安证书》主管机关或认可的保安组织的名称：验证机构的名称（如不同）：
13	船舶在该国注销登记的日期：

兹证明上述记录在各方面均为正确

签发主管机关：中华人民共和国上海海事局

签发地点和日期：上海

授权官员签名：

授权官员姓名：

船舶于（日期）收到本文件并附于《连续概要记录》中。

签字：

表格2

《连续概要记录》文件编号： 的变更表格

（船名），IMO 编号：

表格中显示变化情况，所有未变化的项目应注明“未变化”

日期格式为年/月/日

	信息
1	本文件适用起始日期：
2	船旗国：
3	在该国的船舶登记日期：
4	船名：
5	船籍港：
6	船舶所有人：登记地址：
7	光船承租人：登记地址：
8	《国际安全管理规则》所定义的公司名称：登记地址：开展安全管理活动的地址：
9	船舶所入级的所有船级社的名称：
10	向经营该船的公司签发《符合证明》（或《临时符合证明》）的主管机关的名称：
11	向船舶签发《安全管理证书》的认可组织的名称：
12	向船舶签发《国际船舶保安证书》或《临时国际船舶保安证书》主管机关或认可的保安组织的名称：验证机构的名称（如不同）：
13	船舶在该国注销登记的日期：

兹证明上述记录在各方面均为正确

签发公司或船长：

签发日期

授权人员签名：

授权人员姓名：

表格 3

《连续概要记录》文件编号： 的变更索引表

（船名），IMO 编号：

《连续概要记录》签发后，公司或船长已对文件中的下列记载项目作了变更，变更已附在《连续概要记录》中并告之海事主管机关

变更项目发生日期:	变更项目（2---- 13）	变更表格纳入《连续概要记录》日期

备注：如此页不够填写，可复制表格。表格应从“1”起编号，并注明：已附加表格（页码：）

_____

FORM 1

CONTINUOUS SYNOPSIS RECORD (CSR) DOCUMENT NUMBER 1 FOR

THE SHIP WITH IMO NUMBER: IMO

Dates should be in the format yyyy/mm/dd.

	Information
1	This document applies from (date):	2004/07/01
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): Registered address(es):
7	If applicable, name of current registered bareboat charterer(s): Registered address(es):
8	Name of Company (International Safety Management): Registered address(es): Address(es) of its safety management activities:
9	Name of all classification societies with which the ship is classed:
10	Administration/Government/Recognized Organization which issued Document of Compliance: Body which carried out audit (if different):
11	Administration/Government/Recognized Organization which issued Safety Management Certificate: Body which carried out audit (if different):
12	Administration/Government/Recognized Security Organization which issued International Ship Security Certificate: Body which carried out verification (if different):
13	Date on which the ship ceased to be registered with the State indicated in 2:

THIS IS TO CERTIFY THAT this record is correct in all respects

Issued by the Administration of: SHANGHAI MARITIME SAFETY ADMINISTRATION

OF THE PEOPLE’S REPUBLIC OF CHINA

Place and date of issue: SHANGHAI

Signature of authorized person:

Name of authorized person:

This document was received by the ship and attached to the ship.s CSR file on the following date

(fill in): Signature:

FORM 2

AMENDMENTS TO THE CONTINUOUS SYNOPSIS RECORD (CSR) DOCUMENT

NUMBER FOR THE SHIP WITH IMO NUMBER: IMO

The amendments are shown in the table. Indicate N/C for all items not being changed. Dates should be in the format yyyy/mm/dd.

	Information
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): Registered address(es):
7	If applicable, name of current registered bareboat charterer(s): Registered address(es):
8	Name of Company (International Safety Management): Registered address(es): Address(es) of its safety management activities:
9	Name of all classification societies with which the ship is classed:
10	Administration/Government/Recognized Organization which issued Document of Compliance: Body which carried out audit (if different):
11	Administration/Government/Recognized Organization which issued Safety Management Certificate: Body which carried out audit (if different):
12	Administration/Government/Recognized Security Organization which issued International Ship Security Certificate: Body which carried out verification (if different):
13	Date on which the ship ceased to be registered with the State indicated in 2:

THIS IS TO CERTIFY THAT this record is correct in all respects

Issued by the Company or master:

Date of issue:

Signature of authorized person:

Name of authorized person:

FORM 3

INDEX OF AMENDMENTS TO CSR DOCUMENT NUMBER FOR

THE SHIP WITH IMO NUMBER: IMO

After this CSR document was issued, the following amendments to entries on the document have been made by the Company or the master, have been attached to the ship.s CSR file and have been notified to the Administration:

Date of application of Amendments:	Amendment to CSR Information (2. 13)	Date amendment form attached to the ship.s CSR file :

NOTE: If more amendments are issued than allowed for in the above table, add copies of this table as Appendices to this page. Such Appendices should be numbered from 1 and upwards. When relevant, indicate as follows: Appendix no. .... has been added to this page.

连续概要记录格式

信息

信息

Information

THIS IS TO CERTIFY THAT this record is correct in all respects

FORM 2

AMENDMENTS TO THE CONTINUOUS SYNOPSIS RECORD (CSR) DOCUMENT

Information

FORM 3