Director
Department of Merchant Shipping
P.O. Box 56193 - 3305 3305 Limassol
Fax Number 25 84 82 00 / Email : [email protected]
Form ISPS C-1
SOLAS Ch. XI-2 and the ISPS Code
Nomination of the Company Security Officer, his/her Alternate and the RSO
(to be completed by an authorized representative of the Company) 1 - (to be used also for reporting changes)
1.
Company (as defined in SOLAS regulation XI-2/1.1.7)2
Registered Name:
Registered address:
Business address:
IMO Unique Company ID
Telephone (main):
Fax (main):
e-mail (main):
Telex: 3
2.
Company Security Officer (CSO)
2.1. CSO
name):
2.2
4
(First name and surname or family
Alternate CSO.
name):
5
(First name and surname or family
Contact Details6
CSO
Alternate CSO
Telephone (Office):
Telephone (Office):
Fax (Office):
Fax (Office):
e-mail (Office):
e-mail(Office):
Telex:
2
Telex: 2
Telephone (A.O.H):
Telephone (A.O.H):
Mobile telephone:
Mobile telephone:
1:
2
All information to be clearly typed –no hand writing
Information provided on the registered and business address to be the same as those provided on the ISM
form
3
Complete only if the information is available
4
: Company Security Officer means the person defined as per ISPS Code Part A/2.7.
5
: Alternate Company Security Officer means the person defined as per DMS Circular 14/2003 par. 10.2.
6
Contact details to be appended in the approved Ship Security Plan (SSP) as per Circular 14/2003, par. 10.2
Rev. 21-12-11
Form ISPS C-1
3. Nomination of the Recognized Security Organization (RSO)
Company Security
Officer
(as shown in 2.1)
RSO7 Nomination
Ship’s Particulars
Name
IMO Number
Call Sign
SSPA8
ISSC9
The undersigned hereby declare and state that I am duly authorized by the Company and the aforesaid persons to
provide the information contained herein. I also declare and state that all Cyprus flag ships owned / operated by the
above Company are monitored by the aforesaid personnel for the receipt, processing, relay and safekeeping of
security related matters, as per SOLAS Ch. XI – 2 and ISPS Code.
Signature
Date:
Name:
Title:
Company Seal
Chose the case/cases concerned for the submission of the ISPS C1 Form10
New building - first registration
Change of Company name
Change of flag to Cyprus
Change of Company address
Change of Ship’s name
Change of Company (new manager)
Change of RSO for SSPA
Change of CSO / alt CSO contact details
Change of RSO for SSP
Change of CSO / alt CSO
7
8
9
10
ABS, BV, CCS, DNV, GL, KRS, LRS, NKK, PRS, RINA, RMRS are the only Classification Societies authorized
by the Republic of Cyprus to approve the Ship Security Plan (SSP) and issue the International Ship Security
Certificate (ISSC) to a Cyprus ship
Ship Security Plan Approval
International Ship Security Certificate (ISSC)
For changes related to changes on the Continuous Synopsis Record (CSR), a written request must be
submitted for the change of the CSR (email to [email protected] ) accompanied with related
documents and copies of the ISPS C2 and C3 forms (original forms to be placed in the ship’s CSR file)
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