AMENDMENTS TO THE CONTINUOUS SYNOPSIS RECORD (CSR) DOCUMENT NO 09 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 Registered owner identification number
8 If applicable, name of current registered
bareboat chatterer(s):
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 (DOC):
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):
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 Captain or Master: ……………….…………
(Signature)
Name of the Captain or Master: ……………….………………………………..
Date of issue: …2020/21/09…………………………………………............
Valid upto : …………………….…………………. (three months from date of issue