Annex Ⅲ授权委托书 1
Letter of authorization
委托人：
Principal:
住所地：
Domicile:
法定代表人：
Legal representative:联系人：Contact person:
通讯地址：
Correspondence address:电话：Telephone:
传真：
Fax:
电子信箱：
E-mail:Name of the contracted ship: ____________________________________________
签约船名：_________________________________________________________

代理人（代理公司名称或代理船长姓名*）：
Agent (name of agency or Master*):
住所地：
Domicile:
法定代表人（仅限代理公司)：
Legal representative (only for agency):联系人：Contact person :通讯地址：Correspondence address:电话：Telephone:
传真：
Fax:
电子信箱：
E-mail:*委托人仅可以在紧急情况下或者船舶没有预先计划突然需要挂靠中国港口时，委托船长代为签订《船舶污染清除协议》*The Principal can only authorize the Master to sign the Agreement under an emergency or when the ship need tocall at Chinese ports without a prior schedule.
IG	  LoA	  dated	  6	  December	  2011	  	  	   Page	  1	  

Pursuant to the requirements of the Regulations of the PRC on Administration of thePrevention and Control of Marine Environment Pollution from Ships, Regulations ofthe PRC on Emergency Preparedness and Response on Marine Environment Pollution
from Ships and the Detailed Rules of Maritime Safety Administration of the PRC onthe Implementation of the Administration Regime of Agreement for Ship Pollution
Response, our company hereby appoint your good company (or the Master of thecontracted ship) as our agent as defined by Paragraph 3 of Article 18 of the Detailed
Rules of Maritime Safety Administration of the PRC on the Implementation of theAdministration Regime of Agreement for Ship Pollution Response with respect to thesigning of the Agreement for Ship Pollution Response (hereafter “the Agreement”)
and other relevant issues.
根据《中华人民共和国防治船舶污染海洋环境管理条例》，《中华人民共和国船舶污染海洋环境应急防备和应急处置管理规定》、《中华人民共和国海事局船舶污染清除协议管理制度实施细则》的有关规定的要求，我司特授权贵司（或签约船舶的船长）作为我司为《中华人民共和国海事局船舶污染清除协议管理制度实
施细则》第18条第三款的规定的代理人，代为我司签署《船舶污染清除协议》和处理相关事宜。
The authorisation provided to the agent by the means of this letter is limited to thefollowing:贵司的代理权限如下：To negotiate with the PRC corresponding qualified ship pollution responseorganization on terms and clauses of the Agreement and on revision, extension andtermination of the Agreement after the Agreement is signed;
与获得中国主管部门认可相应资质的船舶污染清除单位协商《船舶污染清除协议》的条件和条款, 以及合同成立之后的对于该合同的修改、延期和终止；To sign the Agreement for Ship Pollution Response on behalf of our company;
代理我司签署《船舶污染清除协议》；
To submit and to file the signed Agreement with PRC Maritime Safety
Administrations in charge.
代理我司向主管海事局提交、报备已签署的《船舶污染清除协议》；
Under the instruction of our company, to pay the ship pollution response retainer fee
under the Agreement and to collect the refunding of the said retainer fee according to
the signed Agreement on behalf of our company; to receive the receipt of the said
retainer fee;
根据我司指示，依据《船舶污染清除协议》之规定，代理我司向船舶污染清除单位支付船舶的协议费，代为收取退回的船舶的协议费；并领取有关付款收据；To deal with any other issues relevant to the signing of the Agreement as instructedby our company.
代为办理我司指示的与签署《船舶污染清除协议》有关的其他事务；IG	  LoA	  dated	  6	  December	  2011	  	  	   Page	  2	  This Authorization shall cease to be effective when the contracted ship departs fromthe service zone for a voyage Agreement, and this Authorization shall cease to beeffective for a time Agreement when the term of the Agreement as agreed expires.
在签订航次《船舶污染清除协议》时，本授权委托书自所代理船舶驶离《船舶污染清除协议》的服务区域时失效；在签订固定期限的《船舶污染清除协议》时，本授权委托书在双方约定的合同期限届满时失效。
This Authorization applies only in the following ports (if applicable):委 托 人：1
Principal:
法定代表人：Legal Representative ：(Signature of legal representative and company seal)
日期（DATE）：IG	  LoA	  dated	  6	  December	  2011	  	  	   Page	  3