1、CHINA CLASSIFICATION SOCIETYREQUEST FOR CERTIFICATION(This form in duplicate may be submitted through the local office of this Society) We hereby request China Classification Society to carry out verification to EEMS of the following Company and to issue the Company Energy Efficiency Management Cert

2、ificate (CEEMC) or endorse the current CEEMC according to . We promise to provide appropriate safety audit conditions for attending auditors in accordance with the appropriate mandatory safety requirements and the recommendations specified in the Guideline for Surveyor Occupational Health and Safety

3、 of this society.Company Information:Name of Company Address of the company (registered address & operational address) Contact PersonManagement Rep.Tel No.Fax No.E-mailPost codeCEEMC No(if have)Issued byKinds of Verification Initial Verification Annual Verification Renewal Verification Additional Ve

4、rification Place of VerificationDate of VerificationLanguage of AuditCompany identification numberVessels covered by EEMSType of ShipNumber of ships covered by applying CEEMCFlag Bulk carrier Gas tanker Tanker Container ship General cargo ship Refrigerated cargo carrier Combination carrier Passenger

5、 ship Ro-ro cargo ship(vehicle carrier) Ro-ro cargo ship Ro-ro passenger shipAppendix: Energy Efficiency Management Manual/CEEMP Procedures List of procedures, instructions & other materials Energy Efficiency data Energy Efficiency self-evaluation report We agree to pay the verification fee, in addi

6、tion, any travelling and other expenses incurred by the verification in connection with the verification. It is understood that in the event of this project not being completed under the Societys verification, the Society reserves the right to charge its service pro rataMarks to be used: FORMCHECKBO

7、X Applicable FORMCHECKBOX Not applicable （Rev.0 20170901-1/3）中 國(guó) 船 級(jí) 社CHINA CLASSIFICATION SOCIETYREQUEST FOR CERTIFICATIONThe results of review of the follow-up corrective action during the last verification(not applicable for initial verifications):Change of EEMS documentation(if any) AAAApplicant (Stamp) Date （Rev.0 20170901-2/3）中 國(guó) 船 級(jí) 社CHINA CLASSIFICATION SOCIETYREQUEST FOR