The Offshore Pollution Liability Association Ltd

Form D (OTHER THAN WELL)

OPERATOR'S NOTIFICATION OF DESIGNATED OFFSHORE FACILITIES

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To: The Offshore Pollution Liability Association Limited

Licence Number ...........................................................................................

Block Nos./Field Name.................................................................................

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(2)	that the following Designated Offshore Facilities have been withdrawn from the Licensed Area covered by the Designation of Licence.

Permanent Designated Facility	Description/Name	Start Date	Cease Date
Production Platform	..............................................................	.......................	.....................
Subsea Development	..............................................................	.......................	.....................
Pipeline/Tie back system	..............................................................	.......................	.....................
Crude Oil Storage & Loading System	..............................................................	.......................	.....................
Crude Oil Loading System	..............................................................	.......................	.....................
Other	..............................................................	.......................	.....................

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

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

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

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

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

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