Continuous Synopsis Record (CSR) Document Number ............... for the Ship with IMO Number: IMO...............

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 charterer(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:
	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):
15	Date on which the ship ceased to be registered with the State indicated in 2:
16	Remarks (insert relevant information as appropriate)
THIS IS TO CERTIFY THAT this record is correct in all respects
Issued by the Administration of:....................................................
Place and date of issue:................................................................
Signature of authorized person:....................................................
Name of authorized person:..........................................................

This document was received by the ship and attached to the ship's CSR file on the following date
(fill in):.................................... Signature:........................................