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1、No. de Control: F-SEG-01-06-01Versin: 00Fecha: 03 de octubre de 2008Pgina 1 de 2PANAMA MARITIME AUTHORITY Technical Office Segumar Panama Pan-Canal Building 4th fl., Omar Torrijos Herrera Ave. Albrook Panama City, PanamaAPPLICATION FOR SERVICE STATION APPROVAL (*Incomplete applications will be decli
2、ned*)Name of Recommended Service Station 贵司填写（英文）Address贵司填写 （英文）Telephone贵司填写 Fax贵司填写 E-mail贵司填写Vessel name / IMO船东填写1.Name of Class Society/Recognized Organization responsible for the issuance of the relevant Statutory Certificate: (Please attach copy)Approved byClass : 贵司填写2.Name of the IACS memb
3、er (Class Society) or Manufacturer who accredited/approved the recommended Service Station: (Please attach copy of their approval/certification)Approved byClass/Manufacturer: 贵司填写3.Reason why original manufacturer representative cannot attend the service/inspection: We cannot find the service statio
4、n for the original manufacturers in JING TANG PORT,CHINA then the above service cannot be carried out on time .4.Please fill out the next page according to the equipment to be inspected / served. Tel: (507) 501-5361/62/50 Fax: (507) 501-5363/64 E-mail: No. de Control: F-SEG-01-06-01Versin: 00Fecha:
5、03 de octubre de 2008Pgina 2 de 2PANAMA MARITIME AUTHORITY Technical Office Segumar Panama Pan-Canal Building 4th fl., Omar Torrijos Herrera Ave. Albrook Panama City, PanamaATTACHMENT FOR SERVICE STATION APPROVAL (Brand name of equipment authorized to service AS PER INTERIM CERT.)EquipmentManufacturer LifeboatFUKAYA,JAPAN Release gearVIDER CO.,LTD,JAPAN WinchVIDER CO.,LTD,JAPAN
