Appendix A5-II
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Statutory Documents - ILO Conventions - International Labour Conference – Maritime Labour Convention, 2006 - The Regulations and the Code - Title 5 – Compliance and enforcement - Appendix A5-II

Appendix A5-II

Maritime Labour Certificate
(Note: This Certificate shall have a Declaration of Maritime Labour Compliance attached)
Issued under the provisions of Article V and Title 5 of the
Maritime Labour Convention, 2006
(referred to below as “the Convention”)
under the authority of the Government of:
..............................................................................................................................................................................
(full designation of the State whose flag the ship is entitled to fly)
by .........................................................................................................................................................................
(full designation and address of the competent authority or recognized organization duly authorized under the provisions of the Convention)
Particulars of the ship
Name of ship ....................................................................................................................................................
Distinctive number or letters ..........................................................................................................................
Port of registry ...................................................................................................................................................
Date of registry .................................................................................................................................................
Gross tonnagefootnote .................................................................................................................................................
IMO number ......................................................................................................................................................
Type of ship .......................................................................................................................................................
Name and address of the shipowner footnote..........................................................................................................
..............................................................................................................................................................................
..............................................................................................................................................................................
This is to certify:
1. That this ship has been inspected and verified to be in compliance with the requirements of the Convention, and the provisions of the attached Declaration of Maritime Labour Compliance.
2. That the seafarers’ working and living conditions specified in Appendix A5-I of the Convention were found to correspond to the above mentioned country’s national requirements implementing the Convention. These national requirements are summarized in the Declaration of Maritime Labour Compliance, Part I.
This Certificate is valid until .................................... subject to inspections in accordance with Standards A5.1.3 and A5.1.4 of the Convention.
This Certificate is valid only when the Declaration of Maritime Labour Compliance issued
at ................................................................. on ................................................... is attached.
Completion date of the inspection on which this Certificate is based was .........................................
Issued at .................................................... on .................................................................................................
Signature of the duly authorized official issuing the Certificate
(Seal or stamp of issuing authority, as appropriate)
 
Endorsements for mandatory intermediate inspection and, if required, any additional inspection
This is to certify that the ship was inspected in accordance with Standards A5.1.3 and A5.1.4 of the Convention and that the seafarers’ working and living conditions specified in Appendix A5-I of the Convention were found to correspond to the above-mentioned country’s national requirements implementing the Convention.
Intermediate inspection: Signed .................................................................
(to be completed between the second and third anniversary dates) (Signature of authorized official)
  Place ...................................................................
  Date ....................................................................
  (Seal or stamp of the authority, as appropriate)
Additional endorsements (if required)
This is to certify that the ship was the subject of an additional inspection for the purpose of verifying that the ship continued to be in compliance with the national requirements implementing the Convention, as required by Standard A3.1, paragraph 3, of the Convention (re-registration or substantial alteration of accommodation) or for other reasons.
Additional inspection: Signed .................................................................
(if required) (Signature of authorized official)
  Place ...................................................................
  Date ....................................................................
  (Seal or stamp of the authority, as appropriate)
 
Additional inspection: Signed .................................................................
(if required) (Signature of authorized official)
  Place ...................................................................
  Date ....................................................................
  (Seal or stamp of the authority, as appropriate)
 
Additional inspection: Signed .................................................................
(if required) (Signature of authorized official)
  Place ...................................................................
  Date ....................................................................
  (Seal or stamp of the authority, as appropriate)
Extension after renewal inspection (if required)
 
This is to certify that, following a renewal inspection, the ship was found to continue to be in compliance with national laws and regulations or other measures implementing the requirements of this Convention, and that the present certificate is hereby extended, in accordance with paragraph 4 of Standard A5.1.3, until.................................................. (not more than five months after the expiry date of the existing certificate) to allow for the new certificate to be issued to and made available on board the ship.
Completion date of the renewal inspection on which this extension is based was..........................................
............................................................................
Signed .................................................................
(Signature of authorized official)
Place ...................................................................
Date ....................................................................
(Seal or stamp of the authority, as appropriate)
Maritime Labour Convention, 2006
Declaration of Maritime Labour Compliance – Part I
(Note: This Declaration must be attached to the ship’s Maritime Labour Certificate)
Issued under the authority of: .................................. (insert name of competent authority as defined in Article II, paragraph 1(a), of the Convention )
With respect to the provisions of the Maritime Labour Convention, 2006, the following referenced ship:
Name of ship IMO number Gross tonnage
     
is maintained in accordance with Standard A5.1.3 of the Convention.
The undersigned declares, on behalf of the abovementioned competent authority, that:
(a) the provisions of the Maritime Labour Convention are fully embodied in the national requirements referred to below;
(b) these national requirements are contained in the national provisions referenced below; explanations concerning the content of those provisions are provided where necessary;
(c) the details of any substantial equivalencies under Article VI, paragraphs 3 and 4, are provided <under the corresponding national requirement listed below> <in the section provided for this purpose below> (strike out the statement which is not applicable);
(d) any exemptions granted by the competent authority in accordance with Title 3 are clearly indicated in the section provided for this purpose below; and
(e) any ship-type specific requirements under national legislation are also referenced under the requirements concerned.
1. Minimum age (Regulation 1.1)
2. Medical certification (Regulation 1.2) ..............................................................................................................................................................................................
3. Qualifications of seafarers (Regulation 1.3) ..................................................................................................................................................................................
4. Seafarers’ employment agreements (Regulation 2.1) ................................................................................................................................................................
5. Use of any licensed or certified or regulated private recruitment and placement service (Regulation 1.4) .................................................................................................................................................................................................................................................................
6. Hours of work or rest (Regulation 2.3) ............................................................................................................................................................................................
7. Manning levels for the ship (Regulation 2.7) .................................................................................................................................................................................
8. Accommodation (Regulation 3.1) ....................................................................................................................................................................................................
9. On-board recreational facilities (Regulation 3.1) ..........................................................................................................................................................................
10. Food and catering (Regulation 3.2) .................................................................................................................................................................................................
11. Health and safety and accident prevention (Regulation 4.3) ......................................................................................................................................................
12. On-board medical care (Regulation 4.1) ........................................................................................................................................................................................
13. On-board complaint procedures (Regulation 5.1.5) ....................................................................................................................................................................
14. Payment of wages (Regulation 2.2) ................................................................................................................................................................................................
15. Financial security for repatriation (Regulation 2.5) ................................................................................................................................................................................................
16. Financial security relating to shipowners’ liability (Regulation 4.2) ................................................................................................................................................................................................
    Name: ................................................................................
      Title: ....................................................................................
      Signature: ..........................................................................
      Place: .................................................................................
      Date: ...................................................................................
      (Seal or stamp of the authority, as appropriate)
 
Substantial equivalencies
(Note: Strike out the statement which is not applicable)
The following substantial equivalencies, as provided under Article VI, paragraphs 3 and 4, of the Convention, except where stated above, are noted (insert description if applicable):
..............................................................................................................................................................................................................................................................................
..............................................................................................................................................................................................................................................................................
No equivalency has been granted.  
      Name: ................................................................................
      Title: ....................................................................................
      Signature: ..........................................................................
      Place: .................................................................................
      Date: ...................................................................................
      (Seal or stamp of the authority, as appropriate)
 
Exemptions
(Note: Strike out the statement which is not applicable)
The following exemptions granted by the competent authority as provided in Title 3 of the Convention are noted:
..............................................................................................................................................................................................................................................................................
..............................................................................................................................................................................................................................................................................
No exemption has been granted.  
      Name: ................................................................................
      Title: ....................................................................................
      Signature: ..........................................................................
      Place: .................................................................................
      Date: ...................................................................................
      (Seal or stamp of the authority, as appropriate)
Declaration of Maritime Labour Compliance – Part II
Measures adopted to ensure ongoing compliance between inspections
The following measures have been drawn up by the shipowner, named in the Maritime Labour Certificate to which this Declaration is attached, to ensure ongoing compliance between inspections:
(State below the measures drawn up to ensure compliance with each of the items in Part I)
1. Minimum age (Regulation 1.1) ❑
  .............................................................................................................................................................................................  
2. Medical certification (Regulation 1.2) ❑
  .............................................................................................................................................................................................  
3. Qualifications of seafarers (Regulation 1.3) ❑
  .............................................................................................................................................................................................  
4. Seafarers’ employment agreements (Regulation 2.1) ❑
  .............................................................................................................................................................................................  
5. Use of any licensed or certified or regulated private recruitment and placement service (Regulation 1.4) ❑
  .............................................................................................................................................................................................  
6. Hours of work or rest (Regulation 2.3) ❑
  .............................................................................................................................................................................................  
7. Manning levels for the ship (Regulation 2.7) ❑
  .............................................................................................................................................................................................  
8. Accommodation (Regulation 3.1) ❑
  .............................................................................................................................................................................................  
9. On-board recreational facilities (Regulation 3.1) ❑
  .............................................................................................................................................................................................  
10. Food and catering (Regulation 3.2) ❑
  .............................................................................................................................................................................................  
11. Health and safety and accident prevention (Regulation 4.3) ❑
  .............................................................................................................................................................................................  
12. On-board medical care (Regulation 4.1) ❑
  .............................................................................................................................................................................................  
13. On-board complaint procedures (Regulation 5.1.5) ❑
  .............................................................................................................................................................................................  
14. Payment of wages (Regulation 2.2) ❑
  .............................................................................................................................................................................................  
15. Financial security for repatriation (Regulation 2.5) ❑
  .............................................................................................................................................................................................  
16. Financial security relating to shipowners’ liability (Regulation 4.2) ❑
  .............................................................................................................................................................................................  
I hereby certify that the above measures have been drawn up to ensure ongoing compliance, between inspections, with the requirements listed in Part I.
    Name of shipowner: footnote.......................................................
    .............................................................................................
    Company address: .........................................................
    .............................................................................................
    Name of the authorized signatory: ...............................
    .............................................................................................
    Title: ...................................................................................
    Signature of the authorized signatory: ........................
    .............................................................................................
    Date: ..................................................................................
    (Stamp or seal of the shipowner)
The above measures have been reviewed by (insert name of competent authority or duly recognized organization) and, following inspection of the ship, have been determined as meeting the purposes set out under Standard A5.1.3, paragraph 10(b), regarding measures to ensure initial and ongoing compliance with the requirements set out in Part I of this Declaration.
    Name: ...............................................................................
    Title: ...................................................................................
    Address: ...........................................................................
    .............................................................................................
    .............................................................................................
    Signature: .........................................................................
    Place: ................................................................................
    Date: ..................................................................................
    (Seal or stamp of the authority, as appropriate)
Interim Maritime Labour Certificate
Issued under the provisions of Article V and Title 5 of the
Maritime Labour Convention, 2006
(referred to below as “the Convention”) under the authority of the Government of:
...............................................................................................................................
(full designation of the State whose flag the ship is entitled to fly)
by ...............................................................................................................................
(full designation and address of the competent authority or recognized organization duly authorized under the provisions of the Convention)
Particulars of the ship
Name of ship .....................................................................................................................................................
Distinctive number or letters ...........................................................................................................................
Port of registry ....................................................................................................................................................
Date of registry ..................................................................................................................................................
Gross tonnagefootnote ..................................................................................................................................................
IMO number .......................................................................................................................................................
Type of ship ........................................................................................................................................................
Name and address of the shipowner footnote...........................................................................................................
...............................................................................................................................................................................
This is to certify, for the purposes of Standard A5.1.3, paragraph 7, of the Convention, that:
(a) this ship has been inspected, as far as reasonable and practicable, for the matters listed in Appendix A5-I to the Convention, taking into account verification of items under (b), (c) and (d) below;
(b) the shipowner has demonstrated to the competent authority or recognized organization that the ship has adequate procedures to comply with the Convention;
(c) the master is familiar with the requirements of the Convention and the responsibilities for implementation; and
(d) relevant information has been submitted to the competent authority or recognized organization to produce a Declaration of Maritime Labour Compliance.
This Certificate is valid until .................................... subject to inspections in accordance with Standards A5.1.3 and A5.1.4.
Completion date of the inspection referred to under (a) above was ......................................................
Issued at ..................................................... on .................................................................................................
Signature of the duly authorized official
issuing the interim certificate .........................................................................................................................
(Seal or stamp of issuing authority, as appropriate)
Parent topic: Title 5 – Compliance and enforcement
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