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I4 ENC OrderForm PDF 2021-v3

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ENC/Publications ORDER FORM

Please send completed form by e-mail to: license.marine@i4-insight.com #1

1. END USER INFORMATION


End user category: SOLAS vessel
Vessel/end user name: FOG 15
Vessel Id: IMO no: 9527582 Vessel email fog15@onsatmail.com MMSI: 419001554
Owner/Manager: First Oil and gas services
ECS/ECDIS Manufacturer: Furuno FMD 3100 System Id/eToken no/UPN 3CF624EB8282A291185D43263132

2. ORDER SPECIFICATION – ENC PRODUCTS


Product: AVCS
ENC Service: Manual Licensing

Subscription start date: AUG-22

Fill this out only if requiring FlatFee Subscription:

FlatFee Global Met (Includes Basic weather forecast) FlatFee Global

FlatFee Nav (Includes Basic Weather forecast and Fleet Tracker) FlatFee Zone*

FlatFee Portfolio- Indicate 3 Zones

Zone 1 Zone 2 Zone 3


Zone 4 Zone 5 Zone 6
Zone 7 Zone 8 Zone 9

Yes, I understand that tracking of the vessel is required.

3. ORDER SPECIFICATION – Publications


Select Products ADP AENP

Subscription Start Date

4. DELIVERY ADDRESS (if DVD shipments are required)


Company: NA Att.: NA

Address: NA
Post/Zip code: NA City: NA Country: NA Phone: NA
DVD Update Frequency*: Monthly N/A (Online)
Additional charges incur for DVD shipments
ENC/Publications ORDER FORM
Please send completed form by e-mail to: license.marine@i4-insight.com #2

5. INVOICE ADDRESS
Company: Master Systems LLC Att.: Sachin K Sajeev
Address: Solanki Building, Office 10-13, Al Nuaimiya, Ajman, UAE
Post/Zip code: 14045 City: Ajman Country: United Arab Emirates
Phone: +971 6 5529687

Electronic invoices email: accounts@mastersystems-intl.com Invoice currency NOK USD EUR

Finance dept contact: Telephone:

Organization/VAT registration No.:

6. ORDER INFORMATION

Company: Master Systems


PO Number:

Email address for renewal notifications and send licenses/permits: charts@mastersystems.com


Other comments:

By your signature below, you confirm this order in accordance with the C-MAP Data License Agreement/T Cs , you allow Lloyd’s
Register Voyage AS to transfer license in UKHO portal and you represent that you have the authority to enter into this Agreement
on behalf of the above name entity.

Signature:

Name (capital letters): SIDDHARTH KANDOTH

Date: 26 AUG 2022

Completed by i4 Sales Executive


Discount for Direct/Manual ENC and PAYS
Discount/price for FF service
Discount for ADP
Discount for AENP
#3

Licence Transfer Form Date: 26 AUG 2022

Please complete all sections, in English

If the Shipping Company has recently taken over the management of this vessel, please specify the date they took control:

Former vessel name


FM Licence ID: Vessel Name: (if different from current FM Record): IMO Number:
FOG 15 9527582

With immediate effect from 26 AUG 2022 please transfer control of the following products to the following

ADMIRALTY Distributor: Lloyd’s Register Voyage AS

Note: The With immediate effect from date must not be a date in the future, or more than 8 weeks in the past.
Please do not transfer products for this licence in Fleet Manager before the date given above.

Please specify which products you’d like to transfer by ticking the appropriate boxes below:

- AVCS

- ARCS

- ADP

- AENP

Note: Requests to transfer licences for the ADMIRALTY ECDIS Service cannot be completed via Fleet Manager and must be raised as a
case on the Customer Services Portal.

- ECDIS Service

Company Stamp
Signature:

Print Name: SIDDHARTH KANDOTH


Position in Company: MARINE SUPERINTENDENT
Shipping Company Name: FIRST OIL AND GAS SERVICES

Please note UKHO will inform the previous Distributor(s) of this transfer.
(If company stamp is not
available, please provide
official written approval from
The UK Hydrographic Office, the Shipping Company to the
Admiralty Way, Taunton, Somerset, Distributor on headed paper or
by email, in English).
TA1 2DN, United Kingdom
www.admiralty.co.uk

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