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Registered Address / Place of Business 4. D M M Y Y $ : * Directors / Partners / : Name NRIC No Address Proprietors * (To attach separate page if necessary) 5. Nature of Business (Tick where relevant) : 6. Financial Information (Monthly average) : 7. Shipping Agent Port Agent Ship Chandler Tenants a. b. c. d. Shipping Line Vessel Owner Ferry Operator Others, please Specify : Present monthly transaction No. of Vessel Calls No. of Passengers Quantity of water required.

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