The Offshore Pollution Liability Association Ltd

Form A

APPLICATION TO BECOME A PARTY TO THE OFFSHORE POLLUTION LIABILITY AGREEMENT ("OPOL") AND A MEMBER OF THE OFFSHORE POLLUTION LIABILITY ASSOCIATION LIMITED

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To The Offshore Pollution Liability Association Limited

The undersigned, being or intending to be an Operator of an Offshore Facility, as such terms are
defined in the Offshore Pollution Liability Agreement dated 4th September 1974, as amended from time to time, (hereinafter referred to as "OPOL"), hereby applies to become a Party to OPOL, and, if this application is accepted:

	(i)	agrees to fulfil all the obligations of a Party to OPOL and to be bound by its terms and conditions; and
	(ii)	applies to become a Member of the Offshore Pollution Liability Association Limited (hereinafter referred to as "the Association"), agrees to abide by its Memorandum and Articles of Association and its Rules, and authorises its name to be entered in its Register of Members.
		Signed ............................................................................................... Name (typed)...................................................................................... Title..................................................................................................... Company............................................................................................. Address ..............................................................................................

Application accepted on ...................................................................

Signed .............................................................................................

Title ................................................ .................................................