The Offshore Pollution Liability Association Ltd

Form D (WELL)

OPERATOR'S NOTIFICATION OF DESIGNATED OFFSHORE FACILITIES

You can download/print this form in Word or PDF format simply by clicking on the appropriate icon

If you wish to print individual web pages - please use 'landscape' mode for best results

To The Offshore Pollution Liability Association Limited

With reference to the notice of Designation of Licence(s) (Form C), the undersigned, being a Party to the Offshore Pollution Liability Agreement (hereinafter referred to as "OPOL"), hereby gives notice

(1)	that the provisions of OPOL shall be applicable to the following Designated Offshore Facilities, and/or
(2)	that the following Designated Offshore Facilities have been withdrawn from the Licensed Area covered by the Designation of Licence.

Licence No:	Block No:	Well No:	Rig Name:	Start Date:	Finish Date:
......................	................	..................	...........................................................	.................	...................
......................	................	..................	...........................................................	.................	...................
......................	................	..................	...........................................................	.................	...................
......................	................	..................	...........................................................	.................	...................
......................	................	..................	...........................................................	.................	...................

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

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

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

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

Name .................................................................... (Typed or printed)

Title .......................................................................(Typed or printed)