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CARGO SHIP SAFETY CONSTRUCTION CERTIFICATE
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(Official seal)
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(State)
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Issued under the provisions of the
INTERNATIONAL
CONVENTION FOR THE SAFETY OF LIFE AT SEA, 1974, as modified by the Protocol of
1978 relating thereto
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| under the authority of the Government of
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| _______________________________
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(name of the State)
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| by _______________________________
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(person or organization authorized)
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Particulars of ship
footnote
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| Name of ship
........................................................................................................................
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| Distinctive
number or letters
................................................................................................
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| Port of
registry
.....................................................................................................................
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| Gross
tonnage
.....................................................................................................................
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| Deadweight
of ship (metric tons)footnote
........................................................................................
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| IMO
Numberfootnote
.........................................................................................................................
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| Type of
shipfootnote
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Bulk carrier
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Oil tanker
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Chemical tanker
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Gas carrier
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Cargo ship other than any of the above
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| Date of build:
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Date of
building contract
....................................................................................
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Date on
which keel was laid or ship was at similar stage of construction
....................................................................................
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Date of
delivery
....................................................................................
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Date on
which work for a conversion or an alteration or modification of a major
character was commenced (where applicable)
...........................................................................................
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| All applicable dates shall be completed.
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THIS IS TO CERTIFY:
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| 1 That the
ship has been surveyed in accordance with the requirements of regulation
I/10 of the Convention.
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2 That the
survey showed that:
- .1 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); and
- .2 the ship complied with part
G of chapter II-1 of the Convention using ……. as fuel/N.Afootnote.
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3 That in
implementing regulation I/6(b) the Government has instituted:
- - mandatory annual surveys;
- - unscheduled inspections.
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| 4 That an
Exemption Certificate has/has notfootnote been issued.
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| 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.
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| 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.
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This certificate is valid until
..............................................................................................
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| Completion date of the survey on which this certificate
is based: .................................... (dd/mm/yyyy)
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| Issued at
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(Place of issue of certificate)
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| (Date of Issue)
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(Signature
of authorized official issuing the certificate)
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| (Seal or stamp of the issuing authority, as appropriate)
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INTERMEDIATE SURVEY
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| (for tankers of 10 years of age and over)
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| This is to certify that at an intermediate survey
required by regulation I/10 of the Convention, as modified by the 1978
Protocol, this ship was found to comply with relevant provisions of the
Convention.
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Signed:
…………………………………………………..
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(Signature of
authorized official)
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Place:
……………………………………………………
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Date:
……………………………………………………..
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(Seal or
stamp of the Authority, as appropriate)
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Signed:
…………………………………………………..
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(Signature of
authorized official)
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Place:
……………………………………………………
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Date:
……………………………………………………..
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(Seal or
stamp of the Authority, as appropriate)
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| MANDATORY ANNUAL SURVEYS OR UNSCHEDULED
INSPECTIONS
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| This is to certify that the ship has been surveyed in
accordance with regulation I/6(b) of the Convention, as modified by the 1978
Protocol and the relevant recommendations of the Organization.footnote
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| 1st mandatory annual surveyfootnote, footnote
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Signed:
…………………………………………………..
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| 1st unscheduled inspectionfootnote
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Place:
……………………………………………………
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Date:
……………………………………………………..
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(Seal or
stamp of the Authority, as appropriate)
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| 2nd mandatory annual surveyfootnote, footnote
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Signed:
…………………………………………………..
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| 2nd unscheduled inspectionfootnote
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Place:
……………………………………………………
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Date:
……………………………………………………..
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(Seal or
stamp of the Authority, as appropriate)
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| 3rd mandatory annual surveyfootnote, footnote
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Signed:
…………………………………………………..
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| 3rd unscheduled inspectionfootnote
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Place:
……………………………………………………
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Date:
……………………………………………………..
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(Seal or
stamp of the Authority, as appropriate)
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| 4th mandatory annual surveyfootnote, footnote
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Signed:
…………………………………………………..
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| 4th unscheduled inspectionfootnote
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Place:
……………………………………………………
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Date:
……………………………………………………..
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(Seal or
stamp of the Authority, as appropriate)
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