Gaining society's Transfer of class and re-entry into class

Losing	Society/Fax No.
IACS Permanent Secretariat,	London	+ 44	OJ

Gainin	% Society/Fax No.

To:

From:

Vessel Data After Transfer
Name of Ship		ID No.
Ship Type	Short Code (See Note 6 Overleaf)	Flag
Owner

Part A — Survey Status Request (See Note 1 overleaf)
Name of Ship (Prior to TOC)		ID No. (Prior to TOC)
Gross Tonnage		IMO No.
In accordance with the Transfer of Class Agreement, please provide details of the current survey status, including a full list of overdue surveys, recommendations and conditions of class with respective due dates for the vessel identified above. Attached hereto is a copy of the Owner's authorization for release of the information requested to the gaining Society named on this form.
Date of Request for Class was Received	Date D. M. Y.
Signature	Date D. M. Y.

Part В — Report on Issue of Interim Certificate (See Notes 2 and 3 overleaf)
Date Survey Status Received	D. M. Y.
Change of Owner (Yes/No)		Change of Flag (Yes/No)
Reason for Class Entry	Transfer from another IACS Society
Re-assignment of class to a vessel class withdrawn previously due to a reason other than transfer of class amongst IACS Societies
A list of dates, locations and actions taken to satisfy each overdue survey, overdue recommendations and overdue condition of class as specified to the owner by the losing Society is attached/No relevant items provided by the losing Society (Delete as appropriate).
Date of Issue of Interim Certificate	Date D. M. Y.
Signature	Date D.M. Y.

Part С — Report on Final Entry into Class (See Notes 3 and 4 overleaf)

Date of Entry into Class

A list of dates, locations and actions which have been or will be taken to satisfy each recommendation and condition of class within the due dates as specified to the owner by the losing Society is attached/No relevant items provided by the losing Society (Delete as appropriate).