Application for Consent to Conduct Marine Scientific Research\
in Areas Under National Jurisdiction of

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(name of coastal state)

**Date:\
**\
\
1. [General Information]{.underline}

  ----------------------------------- -----------------------------------
  1.1 Cruise name and/or #:           

  ----------------------------------- -----------------------------------

  ----------------------------------- -----------------------------------
  1.2 Sponsoring institution:         

  Name:                               

  Address:                            

  Name of Director:                   
  ----------------------------------- -----------------------------------

  ----------------------------------- -----------------------------------
  1.3 Scientist in charge of the      
  project (include CV and passport    
  photo):                             

  Name:                               

  Address:                            

  Telephone:                          

  Fax:                                

  Email:                              
  ----------------------------------- -----------------------------------

  ----------------------------------- -----------------------------------
  1.4 Scientist(s) from coastal state 
  involved in the planning of the     
  project:                            

  Name(s):                            

  Address:                            
  ----------------------------------- -----------------------------------

  ----------------------------------- -----------------------------------
  1.5 Submitting officer:             

  Name and address:                   

  Nationality:                        

  Telephone:                          

  Fax:                                

  Email:                              
  ----------------------------------- -----------------------------------

2\. [Description of Project]{.underline} (Attach additional pages as
necessary)

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  2.1 Nature and objectives of the project:

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  2.2 Relevant previous or future research cruises:

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  2.3 Previously published research data relating to the project:

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3\. [Methods and Means to be Used]{.underline}

  ----------------------------------- -----------------------------------
  3.1 Particulars of vessel:          

  Name:                               

  Nationality (Flag state):           

  Owner:                              

  Operator:                           

  Overall length (meters):            

  Maximum draught (meters):           

  Displacement/Gross tonnage:         

  Propulsion:                         

  Cruising & Maximum speed:           

  Call sign:                          

  Method and capability of            
  communication (including emergency  
  frequencies):                       

  Name of master:                     

  Number of crew:                     

  Number of scientists on board:      
  ----------------------------------- -----------------------------------

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  3.2 Aircraft or other craft to be used in the project:

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+-----------------------+-----------------------+-----------------------+
| 3.3 Particulars of    |                       |                       |
| methods and           |                       |                       |
| scientific            |                       |                       |
| instruments           |                       |                       |
+-----------------------+-----------------------+-----------------------+
| > Types of samples    | > Methods to be used  | Instruments to be     |
| > and data            |                       | used                  |
+-----------------------+-----------------------+-----------------------+
|                       |                       |                       |
+-----------------------+-----------------------+-----------------------+
|                       |                       |                       |
+-----------------------+-----------------------+-----------------------+
|                       |                       |                       |
+-----------------------+-----------------------+-----------------------+

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  3.4 Indicate whether harmful substances will be used:

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  3.5 Indicate whether drilling will be carried out:

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  3.6 Indicate whether explosives will be used:

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4\. [Installations and Equipment]{.underline}

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  Details of installations and equipment (dates of laying, servicing,
  recovery; exact locations and depth):

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5\. [Geographical Areas\
]{.underline}

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  5.1 Indicate geographical areas in which the project is to be conducted
  (with reference in latitude and longitude):

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5.2 Attach chart(s) at an appropriate scale (1 page, high-resolution)
showing the geographical areas of the intended work and, as far as
practicable, the positions of intended stations, the tracks of survey
lines, and the locations of installations and equipment.\
\
\
6. [Dates]{.underline}

+-----------------------------------------------------------------------+
| > 6.1 Expected dates of first entry into and final departure from the |
| > research area of the research vessel:                               |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| > 6.2 Indicated if multiple entry is expected:                        |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+

7\. [Port Calls]{.underline}

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  7.1 Dates and names of intended ports of call:

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  7.2 Any special logistical requirements at ports of call:

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+-----------------------------------------------------------------------+
| > 7.3 Name/Address/Telephone of shipping agent (if available):        |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+

8\. [Participation:]{.underline}

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  8.1 Extent to which coastal state will be enabled to participate or to
  be represented in the research project:

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  8.2 Proposed dates and ports for embarkation/disembarkation:

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9\. [Access to data, samples and research results]{.underline}

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  9.1 Expected dates of submission to coastal state of preliminary
  reports, which should include the expected dates of submission of the
  final results:

  No more than 30 days from the end date of the cruise.
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  9.2 Proposed means for access by coastal state to data and samples:

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  9.3 Proposed means to provide coastal state with assessment of data,
  samples and research results or provide assistance in their assessment
  or interpretation:

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  9.4 Proposed means of making results internationally available:

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(Revised June 5, 2002)