Form of Safety Radio Certificate for Cargo Ships
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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 amended
   
under the authority of the Government of
   
_______________________________
(name of the State)
   
by _______________________________
(person or organization authorized)
   
Particulars of ship footnote
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 ....................................................................
   
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)
   
Parent topic: Appendix - Certificates relating to 1974 Convention footnote
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