The Offshore Pollution Liability Association Ltd

Form C

OPERATOR'S DESIGNATION OF LICENCE

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To The Offshore Pollution Liability Association Limited

The undersigned, being a Party to the Offshore Pollution Liability Agreement (hereinafter referred to
as "OPOL"), hereby gives notice that the provisions of OPOL shall be applicable to the following
Designated Licence.

Licensing State...........................................................................................................................

Licensed Area or Licence No ............................................................................................................

Geographic Co-ordinates, Block Nos., or other Identification of Location................................................

Licence issued to:	% INTEREST:
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....................................................................................	.............................
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This Designation is effective .................................................................................... ( Time and Date )

Signed this........... day of .............................. 20.........

Name of Party.....................................................................................................................................

Mailing Address .................................................................................................................................

By .......................................................................... (Authorised Signature)

Name .......................................................................(Typed or Printed)

Title ..........................................................................(Typed or Printed)