Cargo sнip Safety equipment Certificate

This Certificate shall be supplemented

by a Record of Equipment (Form E)

(Official seal) (State)

Issued under the provisions of the International Convention

for the Safety of Life at Sea, 1974, as modified

by the Protocol of 1988 relating thereto

under the authority of the Government of

………………………………………………………………………..…

(Name of the State)

by ………………………………………………………………………..

(Person or organized authorized)

Particulars of ship*

Name of ship ……………………………………..………….

Distinctive number or letters ………………………..……….

Port of registry ……………………………………………….

Gross tonnage ………………………………………..………

Deadweight of ship (metric tons)** …………………………

Length of ship (regulation III/3/12) …………………………

IMO Number ……………………………………………..….

Type of ship***

Bulk carrier

Oil tanker

Chemical tanker

Gas carrier

Cargo ship other than any of the above

Date on which keel was laid or ship was at a similar stage of

construction or, where applicable, date on which work for a conver-

sion or an alteration or modification of a major character was

commenced …………………………………………………….

THIS IS TO CERTIFY:

1. That the ship has been surveyed in accordance with the requirements

of regulation 1/8 of the Convention.

2. That the survey showed that:

_________________

* Alternatively, the particulars of the ship may be placed horizontally in boxes.

** For oil tankers, chemical tankers and gas carriers only.

*** Delete as appropriate.

2.1. the ship complied with the requirements of the Convention as regards fire safety systems and appliances and fire control plans;

2.2. the life-saving appliances and the equipment of lifeboats, liferafts and rescue boats were provided in accordance with the requirements of the Convention;

2.3. the ship was provided with a line-throwing appliances and radio installations used in life-saving appliances in accordance with the requirements of the Convention;

2.4. the ship complied with the requirements of the Convention as regards shipborne navigational equipments, means of embarkation forpilots and nautical publication;

2.5. the ship was provided with lights, shapes, means of making sound signals and distress signals in accordance with the requirements of the Convention and the International Regulations for Preventing Collision at Sea in force;

2.6. in all other respects the ship complied with the relevant requirements of the Convention.

3. That an Exemption Certificate has/has not* been issued.

This Certificate is valid until ……………………** subject to the annual and

periodical surveys in accordance with regulation 1/8 of the Convention.

Issued at ……………………………………………………………...

(Place of issue of Certificate)

………………… ……………………………..

(Date of issue) (Signature of authorized official

issuing the Certificate)

(Seal or stamp of the issuing authority, as appropriate)

Endorsement for annual and intermediate surveys

THIS IS TO CERTIFY that, at survey required by regulation 1/8 of the

Convention, the ship was found to comply with the relevant requirements

of the Convention.

Annual survey: Signed: ………………………..…

(Signature of authorized official)

Place: …………………………….

Date: ………………………..……

(Seal or stamp of authority, as appropriate)

_____________

* Delete as appropriate.

** Insert the date of expiry as specified by the Administration in accordance with regula-

tion 1/14(a) of the Convention. The day and the month of this date correspond to the

anniversary date as defined in regulation 1/2(n) of the Convention, unless amended in

accordance with regulation 1/14(h).

Annual/Periodical* survey: Signed: ………………………..…

(Signature of authorized official)

Place: …………………………….

Date: ………………………..……

(Seal or stamp of authority, as appropriate)

Annual/Periodical* survey: Signed: ………………………..…

(Signature of authorized official)

Place: …………………………….

Date: ………………………..……

(Seal or stamp of authority, as appropriate)

Annual survey: Signed: ………………………..…

(Signature of authorized official)

Place: …………………………….

Date: ………………………..……

(Seal or stamp of authority, as appropriate)

Annual/Periodical survey in accordance with regulation 1/14(h)(iii)

THIS IS TO CERTIFY that, at an annual/periodical* survey in

accordance with regulation 1/14(h)(iii) of the Convention, the ship was

found to comply with the relevant requirements of the Convention.

Signed: …………………………………..…

(Signature of authorized official)

Place: ……………………………………….

Date: …………………………………..……

(Seal or stamp of authority, as appropriate)