Record No.

To: NIPPON KAIJI KYOKAI

　　　　　　　　　　　　　(Fax: 　　　　　　　　　　　　)
Attn.: 　　　　　　　　　　　　　(Inspector)

MLC Shipowner’s Name: ID No.

Ship’s Name: Master’s Name:

Corrective Action Plan Page:　　/

Date:
Representative of Shipowner:
Signature:

I hereby submit corrective action plan for the Non-conformity(ies), specified by the above
Record No., to implement the necessary corrective actions within three months, as follows;
Please itemize actions to be taken together with scheduled date of each action.

Example of Actions (for reference only): * Investigation of root cause. * Tentative measures. * Revision of DMLC Part II and/or relevant
Procedures.* Internal Circular. * Reeducation of Personnel concerned. * Internal Audit. * Recurrence prevention * System Review Meeting

This sheet shall be submitted to the Inspector by . (within two weeks)

In cases of Shipboard Inspection, this sheet shall be submitted to the Inspector via Representative of
Shipowner.
Full-term MLC shall not be issued unless this sheet is submitted to the Inspector.

MLC-CAP (2017.09)