Appendix – Modifications and Additions to the Appendix to the Annex to the International Convention for the Safety of Life at Sea, 1974
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Statutory Documents - IMO Publications and Documents - Resolutions - Maritime Safety Committee - Resolution MSC.344.(91) – Adoption of Amendments to the Protocol of 1988 Relating to the International Convention for the Safety of Life at Sea, 1974 – (Adopted on 30 November 2012) - Annex – Amendments to the Protocol of 1988 Relating to the International Convention for the Safety of Life at Sea, 1974, as Amended - Annex – Modifications and Additions to the Annex to the International Convention for the Safety of Life at Sea, 1974 - Appendix – Modifications and Additions to the Appendix to the Annex to the International Convention for the Safety of Life at Sea, 1974

Appendix – Modifications and Additions to the Appendix to the Annex to the International Convention for the Safety of Life at Sea, 1974

 All the forms of certificates and records of equipment contained in the appendix to the annex are replaced by the following:

Parent topic: Annex – Modifications and Additions to the Annex to the International Convention for the Safety of Life at Sea, 1974

FORM OF SAFETY CERTIFICATE FOR PASSENGER SHIPS

PASSENGER SHIP SAFETY CERTIFICATE
     
This Certificate shall be supplemented by a Record of Equipment for Passenger Ship Safety (Form P)
(Official seal)   (State)
for an/a short footnote international voyage
     
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 organization authorized)
     
Particulars of shipfootnote
Name of ship ........................................................................................................................
Distinctive number or letters ................................................................................................
Port of registry .....................................................................................................................
Gross tonnage .....................................................................................................................
Sea areas in which ship is certified to operate (regulation IV/2) ...............................................
IMO Numberfootnote....................................................................................
Date of build:    
  Date of building contract ....................................................................................
  Date on which keel was laid or ship was at similar stage of construction ....................................................................................
  Date of delivery ....................................................................................
  Date on which work for a conversion or an alteration or modification of a major character was commenced (where applicable) ...........................................
All applicable dates shall be completed.
       
THIS IS TO CERTIFY :
1 That the ship has been surveyed in accordance with the requirements of regulation I/7 of the Convention.
2 That the survey showed that:
2.1 the ship complied with the requirements of the Convention as regards:
.1 the structure, main and auxiliary machinery, boilers and other pressure vessels;
.2 the watertight subdivision arrangements and details;
.3 the following subdivision load lines:
Subdivision load lines assigned and marked on the ship's side amidships (regulation II-1/18)footnote Freeboard To apply when the spaces in which passengers are carried include the following alternative spaces
P1 ........ .......................................................
P2 ........ .......................................................
P3 ........ .......................................................
2.2 the ship complied with the requirements of the Convention as regards structural fire protection, fire safety systems and appliances and fire control plans;
2.3 the life-saving appliances and the equipment of the lifeboats, liferafts and rescue boats were provided in accordance with the requirements of the Convention;
2.4 the ship was provided with a line-throwing appliance and radio installations used in life-saving appliances in accordance with the requirements of the Convention;
2.5 the ship complied with the requirements of the Convention as regards radio installations;
2.6 the functioning of the radio installations used in life-saving appliances complied with the requirements of the Convention;
2.7 the ship complied with the requirements of the Convention as regards shipborne navigational equipment, means of embarkation for pilots and nautical publications;
2.8 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 Collisions at Sea in force;
2.9 in all other respects the ship complied with the relevant requirements of the Convention;
2.10 the ship was/was notfootnote subjected to an alternative design and arrangements in pursuance of regulation(s) II-1/55 / II-2/17 / III/38 footnote of the Convention;
2.11 a Document of approval of alternative design and arrangements for machinery and electrical installations/fire protection/life-saving appliances and arrangementsfootnote is/is notfootnote appended to this Certificate.
3 That an Exemption Certificate has/has notfootnote been issued.
     
This certificate is valid until ..................................................................................................
     
Completion date of the survey on which this certificate is based: .................................... (dd/mm/yyyy)
 
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 where the renewal survey has been completed and regulation I/14(d) applies
     
The ship complies with the relevant requirements of the Convention, and this certificate shall, in accordance with regulation I/14(d) of the Convention, be accepted as valid until.................................................................................
     
Signed: .................................................................................................................................
(Signature of authorized official)
     
Place: ...................................................................................................................................
     
Date: ....................................................................................................................................
     
(Seal or stamp of the 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 I/14(e) or I/14(f) applies
     
This certificate shall, in accordance with regulation I/14(e) / I/14(f) footnote of the Convention, be accepted as valid until...........................
     
Signed: .................................................................................................................................
(Signature of authorized official)
     
Place: ...................................................................................................................................
     
Date: ....................................................................................................................................
     
(Seal or stamp of the authority, as appropriate)

FORM OF SAFETY CONSTRUCTION CERTIFICATE FOR CARGO SHIPS

CARGO SHIP SAFETY CONSTRUCTION CERTIFICATE
   
(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 organization authorized)
   
Particulars of shipfootnote
Name of ship ........................................................................................................................
Distinctive number or letters ................................................................................................
Port of registry .....................................................................................................................
Gross tonnage .....................................................................................................................
Deadweight of ship (metric tons)footnote ........................................................................................
IMO Numberfootnote .........................................................................................................................
 
Type of shipfootnote
  Bulk carrier
  Oil tanker
  Chemical tanker
  Gas carrier
  Cargo ship other than any of the above
 
Date of build:
  Date of building contract ....................................................................................
  Date on which keel was laid or ship was at similar stage of construction ....................................................................................
  Date of delivery ....................................................................................
  Date on which work for a conversion or an alteration or modification of a major character
was commenced (where applicable) ....................................................................................
All applicable dates shall be completed.
THIS IS TO CERTIFY :
1 That the ship has been surveyed in accordance with the requirements of regulation I/10 of the Convention.
2 That the survey showed that the condition of the structure, machinery and equipment as defined in the above regulation was satisfactory and the ship complied with the relevant requirements of chapters II-1 and II-2 of the Convention (other than those relating to fire safety systems and appliances and fire control plans).
3 That the last two inspections of the outside of the ship's bottom took place on ....................................... and ....................................... (dates).
4 That an Exemption Certificate has/has notfootnote been issued.
5 That the ship was/was notfootnote subjected to an alternative design and arrangements in pursuance of regulation(s) II-1/55 / II-2/17 footnote of the Convention.
6 That a Document of approval of alternative design and arrangements for machinery and electrical installations/fire protectionfootnote is/is notfootnote appended to this Certificate.
 
This certificate is valid until footnote.................................................................... subject to the annual and intermediate surveys and inspections of the outside of the ship's bottom in accordance with regulation I/10 of the Convention.
   
Completion date of the survey on which this certificate is based: .................................... (dd/mm/yyyy)
 
   
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 a survey required by regulation I/10 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 the authority, as appropriate)
   
Annual/Intermediatefootnote survey: Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
  (Seal or stamp of the authority, as appropriate)
   
Annual/Intermediatefootnote survey: Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
    (Seal or stamp of the authority, as appropriate)
   
Annual survey: Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
    (Seal or stamp of the authority, as appropriate)
   
Annual/intermediate survey in accordance with regulation I/14(h)(iii)
THIS IS TO CERTIFY that, at an annual/intermediate surveyfootnote in accordance with regulation I/14(h)(iii) of the Convention, this ship was found to comply with the relevant requirements of the Convention.
   
Signed: .................................................................................................................................
(Signature of authorized official)
Place: ...................................................................................................................................
Date: ....................................................................................................................................
(Seal or stamp of the authority, as appropriate)
   
Endorsement for inspections of the outside of the ship's bottomfootnote
THIS IS TO CERTIFY that, at an inspection required by regulation I/10 of the Convention, the ship was found to comply with the relevant requirements of the Convention.
   
First inspection: Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
  (Seal or stamp of the authority, as appropriate)
   
Second inspection: Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
  (Seal or stamp of the authority, as appropriate)
   
Endorsement to extend the certificate if valid for less than 5 years where regulation I/14(c) applies
The ship complies with the relevant requirements of the Convention, and this certificate shall, in accordance with regulation I/14(c) of the Convention, be accepted as valid until ..............................................................................................................................................
   
  Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
  (Seal or stamp of the authority, as appropriate)
   
Endorsement where the renewal survey has been completed and regulation I/14(d) applies
The ship complies with the relevant requirements of the Convention, and this certificate shall, in accordance with regulation I/14(d) of the Convention, be accepted as valid until ..............................................................................................................................................
   
  Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
  (Seal or stamp of the 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 I/14(e) or I/14(f) applies
This certificate shall, in accordance with regulation I/14(e) / I/14(f) footnote of the Convention, be accepted as
valid until ..............................................................................................................................................
   
  Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
  (Seal or stamp of the authority, as appropriate)
   
Endorsement for advancement of anniversary date where regulation I/14(h) applies
In accordance with regulation I/14(h) of the Convention, the new anniversary date is ...............................................................................................................................
   
  Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
    (Seal or stamp of the authority, as appropriate)
   
In accordance with regulation I/14(h) of the Convention, the new anniversary date is ...............................................................................................................................
   
  Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
  (Seal or stamp of the authority, as appropriate)

FORM OF SAFETY EQUIPMENT CERTIFICATE FOR CARGO SHIPS

CARGO SHIP SAFETY EQUIPMENT CERTIFICATE
   
This Certificate shall be supplemented by a Record of Equipment for Cargo Ship Safety (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 organization authorized)
   
Particulars of shipfootnote
Name of ship ........................................................................................................................
Distinctive number or letters ................................................................................................
Port of registry .....................................................................................................................
Gross tonnage .....................................................................................................................
Deadweight of ship (metric tons)footnote ........................................................................................
Length of ship (regulation III/3.12) ........................................................................................
IMO Numberfootnote .........................................................................................................................
 
Type of shipfootnote
  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 conversion 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 I/8 of the Convention.
2 That the survey showed that:
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 the 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 appliance 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 equipment, means of embarkation for pilots and nautical publications;
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 Collisions at Sea in force;
2.6 in all other respects the ship complied with the relevant requirements of the Convention;
2.7 the ship was/was notfootnote subjected to an alternative design and arrangements in pursuance of regulation(s) II-2/17 / III/38 footnote of the Convention;
2.8 a Document of approval of alternative design and arrangements for fire protection/life-saving appliances and arrangementsfootnote is/is notfootnote appended to this Certificate.
3 That the ship operates in accordance with regulation III/26.1.1.1 footnote within the limits of the trade area ………………………………….
4 That an Exemption Certificate has/has notfootnote been issued.
This certificate is valid until ....................................................................footnote subject to the annual and periodical surveys in accordance with regulation I/8 of the Convention.
   
Completion date of the survey on which this certificate is based: .................................... (dd/mm/yyyy)
 
   
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 periodical surveys
THIS IS TO CERTIFY that, at an a survey required by regulation I/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 the authority, as appropriate)
   
Annual/Periodicalfootnotesurvey: Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
  (Seal or stamp of the authority, as appropriate)
   
Annual/Periodicalfootnote survey: Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
  (Seal or stamp of the authority, as appropriate)
   
Annual survey: Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
    (Seal or stamp of the authority, as appropriate)
   
Annual/periodical survey in accordance with regulation I/14(h)(iii)
THIS IS TO CERTIFY that, at an annual/periodicalfootnote survey in accordance with regulation I/14(h)(iii) of the Convention, this ship was found to comply with the relevant requirements of the Convention.
   
  Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
    (Seal or stamp of the authority, as appropriate)
   
Endorsement to extend the certificate if valid for less than 5 years where regulation I/14(c) applies
The ship complies with the relevant requirements of the Convention, and this certificate shall, in accordance with regulation I/14(c) of the Convention, be accepted as valid until ..............................................................................................................................................
   
  Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
  (Seal or stamp of the authority, as appropriate)
   
Endorsement where the renewal survey has been completed and regulation I/14(d) applies
The ship complies with the relevant requirements of the Convention, and this certificate shall, in accordance with regulation I/14(d) of the Convention, be accepted as valid until ..............................................................................................................................................
   
  Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
  (Seal or stamp of the 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 I/14(e) or I/14(f) applies
The certificate shall, in accordance with regulation I/14(e) / I/14(f) footnote of the Convention, be accepted as valid until ................................................................................................
   
  Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
    (Seal or stamp of the authority, as appropriate)
   
Endorsement for advancement of anniversary date where regulation I/14(h) applies
In accordance with regulation I/14(h) of the Convention, the new anniversary date is ...............................................................................................................................
   
  Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
  (Seal or stamp of the authority, as appropriate)
   
In accordance with regulation I/14(h) of the Convention, the new anniversary date is ...............................................................................................................................
   
  Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
  (Seal or stamp of the authority, as appropriate)

FORM OF SAFETY RADIO CERTIFICATE FOR CARGO SHIPS

CARGO SHIP SAFETY RADIO CERTIFICATE
   
This Certificate shall be supplemented by a Record of Equipment for Cargo Ship Safety Radio (Form R)
   
(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 organization authorized)
   
Particulars of shipfootnote
Name of ship ........................................................................................................................................
Distinctive number or letters ................................................................................................................
Port of registry ......................................................................................................................................
Gross tonnage .....................................................................................................................................
Sea areas in which ship is certified to operate (regulation IV/2) .........................................................................................................
IMO Numberfootnote .........................................................................................................................................
Date on which keel was laid or ship was at a similar stage of construction or, where applicable, date on which work for a conversion 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 I/9 of the Convention.
2 That the survey showed that:
2.1 the ship complied with the requirements of the Convention as regards radio installations;
2.2 the functioning of the radio installations used in life-saving appliances complied with the requirements of the Convention.
3 That an Exemption Certificate has/has notfootnote been issued.
   
This certificate is valid until ....................................................................footnote subject to the periodical surveys in accordance with regulation I/9 of the Convention.
   
Completion date of the survey on which this certificate is based: .................................... (dd/mm/yyyy)
 
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 periodical surveys
THIS IS TO CERTIFY that, at a survey required by regulation I/9 of the Convention, the ship was found to comply with the relevant requirements of the Convention.
   
Periodical survey: Signed: ...............................................................
  (Signature of authorized official)
  Place: .................................................................
  Date: ..................................................................
  (Seal or stamp of the authority, as appropriate)
   
Periodical survey: Signed: ...............................................................
  (Signature of authorized official)
  Place: .................................................................
  Date: ..................................................................
  (Seal or stamp of the authority, as appropriate)
   
Periodical survey: Signed: ...............................................................
  (Signature of authorized official)
  Place: .................................................................
  Date: ..................................................................
  (Seal or stamp of the authority, as appropriate)
   
Periodical survey: Signed: ...............................................................
  (Signature of authorized official)
  Place: .................................................................
  Date: ..................................................................
  (Seal or stamp of the authority, as appropriate)
   
Periodical survey in accordance with regulation I/14(h)(iii)
THIS IS TO CERTIFY that, at a periodical survey in accordance with regulation I/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 the authority, as appropriate)
   
Endorsement to extend the certificate if valid for less than 5 years where regulation I/14(c) applies
The ship complies with the relevant requirements of the Convention, and this certificate shall, in accordance with regulation I/14(c) of the Convention, be accepted as valid until .......................................................................
   
  Signed: ...............................................................
  (Signature of authorized official)
  Place: .................................................................
  Date: ..................................................................
  (Seal or stamp of the authority, as appropriate)
   
Endorsement where the renewal survey has been completed and regulation I/14(d) applies
The ship complies with the relevant requirements of the Convention, and this certificate shall, in accordance with regulation I/14(d) of the Convention, be accepted as valid until .......................................................................
   
  Signed: ...............................................................
  (Signature of authorized official)
  Place: .................................................................
  Date: ..................................................................
  (Seal or stamp of the 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 I/14(e) or I/14(f) applies
This certificate shall, in accordance with regulation I/14(e) / I/14(f) footnote of the Convention, be accepted as valid until .......................................................................
   
  Signed: ...............................................................
  (Signature of authorized official)
  Place: .................................................................
  Date: ..................................................................
  (Seal or stamp of the authority, as appropriate)
   
Endorsement for advancement of anniversary date where regulation I/14(h) applies
In accordance with regulation I/14(h) of the Convention, the new anniversary date is .......................................................................
   
  Signed: ...............................................................
  (Signature of authorized official)
  Place: .................................................................
  Date: ..................................................................
  (Seal or stamp of the authority, as appropriate)
   
In accordance with regulation I/14(h) of the Convention, the new anniversary date is .......................................................................
   
  Signed: ...............................................................
  (Signature of authorized official)
  Place: .................................................................
  Date: ..................................................................
  (Seal or stamp of the authority, as appropriate)

FORM OF SAFETY CERTIFICATE FOR CARGO SHIPS

CARGO SHIP SAFETY CERTIFICATE
   
This Certificate shall be supplemented by a Record of Equipment for Cargo Ship Safety (Form C)
   
(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 organization authorized)
   
Particulars of shipfootnote
Name of ship ........................................................................................................................
Distinctive number or letters ................................................................................................
Port of registry .....................................................................................................................
Gross tonnage .....................................................................................................................
Deadweight of ship (metric tons)footnote .........................................................................................
Length of ship (regulation III/3.12) ........................................................................................
Sea areas in which the ship is certified to operate (regulation IV/2)
IMO Numberfootnote .........................................................................................................................
   
Type of shipfootnote
  Bulk carrier  
  Oil tanker  
  Chemical tanker  
  Gas carrier  
  Cargo ship other than any of the above  
 
Date of Build:  
  Date of building contract ......................................................................................................................
  Date on which keel was laid or ship was at similar stage of construction .................................
  Date of delivery .......................................................................................................................
  Date on which work for a conversion or an alteration or modification of a major character was commenced (where applicable) ......................................................................................
All applicable dates shall be completed.
 
THIS IS TO CERTIFY:
1 That the ship has been surveyed in accordance with the requirements of regulations I/8, I/9 and I/10 of the Convention.
2 That the survey showed that:
2.1 the condition of the structure, machinery and equipment as defined in regulation I/10 was satisfactory and the ship complied with the relevant requirements of chapter II-1 and chapter II-2 of the Convention (other than those relating to fire safety systems and appliances and fire control plans);
2.2 the last two inspections of the outside of the ship's bottom took place on .................................... and .................................... (dates)
2.3 the ship complied with the requirements of the Convention as regards fire safety systems and appliances and fire control plans;
2.4 the life-saving appliances and the equipment of the lifeboats, liferafts and rescue boats were provided in accordance with the requirements of the Convention;
2.5 the ship was provided with a line-throwing appliance and radio installations used in life-saving appliances in accordance with the requirements of the Convention;
2.6 the ship complied with the requirements of the Convention as regards radio installations;
2.7 the functioning of the radio installation used in life-saving appliances complied with the requirements of the Convention;
2.8 the ship complied with the requirements of the Convention as regards shipborne navigational equipment, means of embarkation for pilots and nautical publications;
2.9 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 Collisions at Sea in force;
2.10 in all other respects, the ship complied with the relevant requirements of the Convention;
2.11 the ship was/was notfootnote subjected to an alternative design and arrangements in pursuance of regulation(s) II-1/55 / II-2/17 / III/38 footnote of the Convention;
2.12 a Document of approval of alternative design and arrangements for machinery and electrical installations/fire protection/life-saving appliances and arrangementsfootnote is/is notfootnote appended to this Certificate.
3 That the ship operates in accordance with regulation III/26.1.1.1 footnote within the limits of the trade area…………………………
4 That an Exemption Certificate has/has notfootnote been issued.
This certificate is valid until ...................................footnote subject to the annual, intermediate and periodical surveys and inspections of the outside of the ship's bottom in accordance with regulations I/8, I/9 and I/10 of the Convention.
Completion date of the survey on which this certificate is based: .................................... (dd/mm/yyyy)
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 relating to structure, machinery and equipment referred to in paragraph 2.1 of this certificate
THIS IS TO CERTIFY that, at a survey required by regulation I/10 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 the authority, as appropriate)
   
Annual/Intermediatefootnote survey: Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
    (Seal or stamp of the authority, as appropriate)
   
Annual/Intermediatefootnote survey: Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
    (Seal or stamp of the authority, as appropriate)
   
Annual survey: Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
    (Seal or stamp of the authority, as appropriate)
   
Annual/intermediate survey in accordance with regulation I/14(h)(iii)
THIS IS TO CERTIFY that, at an annual/intermediatefootnote survey in accordance with regulations I/10 and I/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 the authority, as appropriate)
   
Endorsement for inspections of the outside of the ship's bottomfootnote
THIS IS TO CERTIFY that, at an inspection required by regulation I/10 of the Convention, the ship was found to comply with the relevant requirements of the Convention.
   
First inspection: Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
  (Seal or stamp of the authority, as appropriate)
   
Second inspection: Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
    (Seal or stamp of the authority, as appropriate)
   
Endorsement for annual and periodical surveys relating to life-saving appliances and other equipment referred to in paragraphs 2.3, 2.4, 2.5, 2.8 and 2.9 of this certificate
THIS IS TO CERTIFY that, at a survey required by regulation I/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 the authority, as appropriate)
   
Annual/Periodicalfootnote survey: Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
  (Seal or stamp of the authority, as appropriate)
   
Annual/Periodicalfootnote survey: Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
  (Seal or stamp of the authority, as appropriate)
   
Annual survey: Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
  (Seal or stamp of the authority, as appropriate)
   
Annual/periodical survey in accordance with regulation I/14(h)(iii)
THIS IS TO CERTIFY that, at an annual/periodicalfootnote survey in accordance with regulations I/8 and I/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 the authority, as appropriate)
   
Endorsement for periodical surveys relating to radio installations referred to in paragraphs 2.6 and 2.7 of this certificate
THIS IS TO CERTIFY that, at a survey required by regulation I/9 of the Convention, the ship was found to comply with the relevant requirements of the Convention.
   
Periodical survey: Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
  (Seal or stamp of the authority, as appropriate)
   
Periodical survey: Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
  (Seal or stamp of the authority, as appropriate)
   
Periodical survey: Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
    (Seal or stamp of the authority, as appropriate)
   
Periodical survey: Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
    (Seal or stamp of the authority, as appropriate)
   
Periodical survey in accordance with regulation I/14(h)(iii)
THIS IS TO CERTIFY that, at a periodical survey in accordance with regulations I/9 and I/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 the authority, as appropriate)
   
Endorsement to extend the Certificate if valid for less than 5 years where regulation I/14/(c) applies
The ship complies with the relevant requirements of the Convention, and this certificate shall, in accordance with regulation I/14(c) of the Convention, be accepted as valid until ............................................................................
   
  Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
    (Seal or stamp of the authority, as appropriate)
   
Endorsement where the renewal survey has been completed and regulation I/14/(d) applies
The ship complies with the relevant requirements of the Convention, and this certificate shall, in accordance with regulation I/14(d) of the Convention, be accepted as valid until ...........................................................................
   
  Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
    (Seal or stamp of the 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 I/14(e) or I/14(f) applies
This certificate shall, in accordance with regulation I/14(e) / I/14(f) footnote of the Convention, be accepted as valid until ...........................................................................
   
  Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
    (Seal or stamp of the authority, as appropriate)
   
Endorsement for advancement of anniversary date where regulation I/14(h) applies
In accordance with regulation I/14(h) of the Convention, the new anniversary date is ...........................................................................
   
  Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
  (Seal or stamp of the authority, as appropriate)
   
In accordance with regulation I/14(h) of the Convention, the new anniversary date is ...........................................................................
   
  Signed: .......................................................
  (Signature of authorized official)
  Place: .........................................................
  Date: ..........................................................
  (Seal or stamp of the authority, as appropriate)

FORM OF EXEMPTION CERTIFICATE

EXEMPTION CERTIFICATE
   
(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 organization authorized)
   
Particulars of shipfootnote
Name of ship ........................................................................................................................
Distinctive number or letters ................................................................................................
Port of registry .....................................................................................................................
Gross tonnage .....................................................................................................................
IMO Numberfootnote.........................................................................................................................
   
THIS IS TO CERTIFY:
That the ship is, under 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)
   
Endorsement to extend the certificate if valid for less than 5 years where regulation I/14(c) applies
This certificate shall, in accordance with regulation I/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 the authority, as appropriate)
   
Endorsement where the renewal survey has been completed and regulation I/14(d) applies
This certificate shall, in accordance with regulation I/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 the 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 I/14(e) or I/14(f) applies
This certificate shall, in accordance with regulation I/14(e) / I/14(f) footnote 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 the authority, as appropriate)
Copyright 2022 Clasifications Register Group Limited, International Maritime Organization, International Labour Organization or Maritime and Coastguard Agency. All rights reserved. Clasifications Register Group Limited, its affiliates and subsidiaries and their respective officers, employees or agents are, individually and collectively, referred to in this clause as 'Clasifications Register'. Clasifications Register assumes no responsibility and shall not be liable to any person for any loss, damage or expense caused by reliance on the information or advice in this document or howsoever provided, unless that person has signed a contract with the relevant Clasifications Register entity for the provision of this information or advice and in that case any responsibility or liability is exclusively on the terms and conditions set out in that contract.