Application-cum-Agreement For Marinet
This form may take you 10 minutes to fill in. You will need the following information to fill in the form: · UEN (Company Registration No.) · Appointed Information Security Coordinators’ / Authorised Marinet Users’ NRIC / FIN / Passport number(s)
This form may take you 10 minutes to fill in.
You will need the following information to fill in the form:
· UEN (Company Registration No.)
· Appointed Information Security Coordinators’ / Authorised Marinet
Users’ NRIC / FIN / Passport number(s)
How to use this form
FINANCE DEPARTMENT MARITIME AND PORT AUTHORITY OF SINGAPORE 460 ALEXANDRA ROAD #18-00 PSA BUILDING SINGAPORE 119963
Part I - Company Particulars (Application should be made by an authorised officer)
*MPA Account No:
Company Name:
UEN (Company Registration No.)
Company Address - Blk No.
House No
Road Name
Postal Code
Name of Authorised Officer
Designation
Telephone No.
Handphone No.
Fax No.
Email
* Mandatory for using Declaration of vessel's arrival and departure module.
Part II - Description of Business (Please check the appropriate box)
(A)
Shipping Agents/Lines (Container)
(B)
Shipping Agents/Lines (Conventional)
(C)
Haulier/Freight Forwarder
(D)
NVOCC
(E)
Trader
(F)
Bunker Supplier
(G)
Shipyard Operator
(H)
Marine Supplier
(I)
Ship Watcher
(J)
Cargo Survey Company
(K)
Ship Survey Company
(L)
Ship Management Company
(M)
Law Firm
(N)
Government Dept
(P)
Statutory Board
(O)
Others (please specify)
Part III - Personnel Authorised to use Marinet
No
Full Name
NRIC/FIN/
Passport No.
+POW user id (For access of Marinet via POW only)
For Official use only
1
2
3
4
5
6
7
8
9
10
+If you are existing PSA's Portnet on Windows (POW) subscriber and wish to access Marinet through POW, please fill in the actual POW user id in this column. Otherwise, please ignore this column.
Part IV - Appointment of Information Security Coordinators (ISC)
For the purpose of ensuring proper control over the use of the logon id and access to sensitive facility, you are required to appoint at least one and no more than two Information Security Coordinators(ISC) who must be of executive level and above.
First ISC
Second ISC
Name
NRIC/FIN/Passport No.
Specimen Signature
In the event any personnel named in this ISC appointment leaves the company's services, the company must inform MPA immediately and must provide MPA with similar particulars of the person replacing such personnel.
Part V - Undertaking
We agree to subscribe to the abovementioned service(s) and facilities provided by MPA and agree to be bound by the Terms and conditions for the said Marinet Service, a copy of which we hereby acknowledge receipt of. These Terms and Conditions are subject to amendment by MPA from time to time as MPA in its absolute discretion deems fit, notice whereof may be given to us in such manner as MPA deems proper. We also confirm that the information herein given is true and correct.
Signature of Authorised Officer
Date
Company Stamp
Part VI - For official use only
A. Finance Dept
This application cannot be processed immediately for the following reason(s):-
MPA account no. not available
Lack of specimen signature of ISC
Coy regn certificate not attached
Lack of auth officer signature
Part I-Coy particulars not complete
IBG form not attached
______________________ __________________ ______________ Name Signature Date
--The End --