До прибытия в порт освидетельствования или на льготный срок

в случае применения Правила 1/14(е), или 1/14(f)

Настоящее Свидетельство в соответствии с Правилом 1/14(е)/14(f)*

Конвенция признается действительным до ……………, при условии

что Свидетельство ………………., к которому приложено

настоящее Свидетельство, действительно ………………………….

Подписано ……………………………………

(Подпись уполномоченного лица)

Место ………………………………………….

Дата …………………………………………....

(Печать или штамп организации)

___________

* Ненужное зачеркнуть.

Form of Exemption Certificate

EXEMPTION CERTIFICATE

This Certificate shall be supplemented by a Record of Equipment

(Form С)

(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 ………………………………………..………

IMO Number ……………………………………………..….

THIS IS TO CERTIFY:

That the ship is, the authority conferred by regulation …………………….

of the Convention, exempted from the requirements of ………………...the

Convention.

Conditions, if any, on which the Exemption Certificate is granted:

………………………………………………………………………………

Voyages, if any, for which the Exemption Certificate is granted:

………………………………………………………………………………

This Certificate is valid until …………………subject to the ……………..

Certificate, to which this Certificate is attached, remaining valid.

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)

___________

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

Endorsement to extent the Certificate if valid for less than 5 years

where regulation 1/14(c) applies

This Certificate shall, in accordance with regulation 1/14 (c) of the

Convention, be accepted as valid until ……………… subject to the

……………….Certificate, to which this Certificate is attached,

remaining valid.

Signed: …………………………………..…

(Signature of authorized official)

Place: ……………………………………….

Date: …………………………………..……

(Seal or stamp of authority, as appropriate)

Endorsement where the renewal survey has been completed

and regulation 1/14(d) applies

This Certificate shall, in accordance with 1/14(d)of the Convention,

be accepted as valid until …………………………..subject to the

……………….….Certificate, to which this Certificate is attached,

remaining valid.

Signed: ………………………..………………

(Signature of authorized official)

Place: ………………………………………….

Date: …………………………………………..

(Seal or stamp of authority, as appropriate)

Endorsement to extend the validity of the Certificate until reaching

the port of survey or for a period of grace where regulation 1/14(e)