Bunker Convention Certificate (BCLC)

BCC Certificates

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APPLICATION FOR A PALAU CERTIFICATE ATTESTING INSURANCE OR OTHER FINANCIAL SECURITY IS IN FORCE IN ACCORDANCE WITH THE PROVISIONS OF THE International Convention on Civil Liability for Bunker Oil Pollution Damage 2001
Subject to the provisions of TheInternational Convention on Civil Liability for Bunker Oil Pollution Damage 2001:
Please complete the information below:
Required fields are marked*:
Full name of Applicant*
Name of Registered Owner / Country where registered*
Place / Country of Application*
Full address of the principal place of business of the Registered Owner*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone Number*
Address where the certificate(s) is/are to be sent (if other from the above)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
E-mail Address*
Vessels
Number of Vessels*
Please enter a value between 1 and 10.
1st Vessel
Name of vessel*
Registered Owner*
Address of Registered Owner*
IMO Number*
Gross Tonnage*
Call Sign*
Flag State*
Port of Registry*
P&I Club or Other approved Insurer*
Upload Certificate of Registry.pdf
Accepted file types: pdf.
Upload Blue Card .pdf
Accepted file types: pdf.
IMPORTANT NOTE - Blue Card is always addressed to:
(1) Palau International Ship Registry (PISR) Europe Head Office Piraeus, Greece, 18536 5, Sachtouri Street, 6th floor T: +30 210 4293500 F: +30 210 4293505 OR (2) Palau International Ship Registry (PISR) USA Head Office The Woodlands, TX, 77380, 9595 Six Pines Drive, Suite 8210, Office 277 T: +1 832 631 6061 F: +1 832 631 6001
2nd Vessel
Name of vessel*
Registered Owner*
Address of Registered Owner*
IMO Number*
Gross Tonnage*
Call Sign*
Flag State*
Port of Registry*
P&I Club or Other approved Insurer*
Upload CoR .pdf
Accepted file types: pdf.
Upload Blue Card .pdf
Accepted file types: pdf.
3rd Vessel
Name of vessel*
Registered Owner*
Address of Registered Owner*
IMO Number*
Gross Tonnage*
Call Sign*
Flag State*
Port of Registry*
P&I Club or Other approved Insurer*
Upload CoR .pdf
Accepted file types: pdf.
Upload Blue Card .pdf
Accepted file types: pdf.
4th Vessel
Name of vessel*
Registered Owner*
Address of Registered Owner*
IMO Number*
Gross Tonnage*
Call Sign*
Flag State*
Port of Registry*
P&I Club or Other approved Insurer*
Upload CoR .pdf
Accepted file types: pdf.
Upload Blue Card .pdf
Accepted file types: pdf.
5th Vessel
Name of vessel*
Registered Owner*
Address of Registered Owner*
IMO Number*
Gross Tonnage*
Call Sign*
Flag State*
Port of Registry*
P&I Club or Other approved Insurer*
Upload CoR .pdf
Accepted file types: pdf.
Upload Blue Card .pdf
Accepted file types: pdf.
6th Vessel
Name of vessel*
Registered Owner*
Address of Registered Owner*
IMO Number*
Gross Tonnage*
Call Sign*
Flag State*
Port of Registry*
P&I Club or Other approved Insurer*
Upload CoR .pdf
Accepted file types: pdf.
Upload Blue Card .pdf
Accepted file types: pdf.
7th Vessel
Name of vessel*
Registered Owner*
Address of Registered Owner*
IMO Number*
Gross Tonnage*
Call Sign*
Flag State*
Port of Registry*
P&I Club or Other approved Insurer*
Upload CoR .pdf
Accepted file types: pdf.
Upload Blue Card .pdf
Accepted file types: pdf.
8th Vessel
Name of vessel*
Registered Owner*
Address of Registered Owner*
IMO Number*
Gross Tonnage*
Call Sign*
Flag State*
Port of Registry*
P&I Club or Other approved Insurer*
Upload CoR .pdf
Accepted file types: pdf.
Upload Blue Card .pdf
Accepted file types: pdf.
9th Vessel
Name of vessel*
Registered Owner*
Address of Registered Owner*
IMO Number*
Gross Tonnage*
Call Sign*
Flag State*
Port of Registry*
P&I Club or Other approved Insurer*
Upload CoR .pdf
Accepted file types: pdf.
Upload Blue Card .pdf
Accepted file types: pdf.
10th Vessel
Name of vessel*
Registered Owner*
Address of Registered Owner*
IMO Number*
Gross Tonnage*
Call Sign*
Flag State*
Port of Registry*
P&I Club or Other approved Insurer*
Upload Certificate of Registry.pdf
Accepted file types: pdf.
Upload Blue Card .pdf
Accepted file types: pdf.
Cost
Certificate(s) Cost
Price: $0.00
Miscellaneous
$70.00
Total Cost
$0.00
Payment Method*
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BCC Certificates

Vessels

1st Vessel

IMPORTANT NOTE - Blue Card is always addressed to:

2nd Vessel

3rd Vessel

4th Vessel

5th Vessel

6th Vessel

7th Vessel

8th Vessel

9th Vessel

10th Vessel

Cost

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