The Government of ………………………. has approved on ………………… an alternative design and
                           arrangement in accordance with provisions of regulation II-1/55 of the International
                           Convention for the Safety of Life at Sea (SOLAS), 1974, as amended, as described
                           below:
                     
                     
                     
                     
                        
                           
                              
                                 | Name of
                                    ship
                                    
                                  | 
                                  
                                    
                                  | 
                                 ...................................................................................................
                                    
                                  | 
                              
                              
                                 | Port of
                                    registry
                                    
                                  | 
                                  
                                    
                                  | 
                                 ...................................................................................................
                                    
                                  | 
                              
                              
                                 | Ship type
                                    
                                  | 
                                  
                                    
                                  | 
                                 ...................................................................................................
                                    
                                  | 
                              
                              
                                 | IMO Number
                                    
                                  | 
                                  
                                    
                                  | 
                                 ...................................................................................................
                                    
                                  | 
                              
                           
                        
                        
                      
                     
                     
                     
                     1. Scope of the analysis or design, including the critical design assumptions and
                        critical design features: 
                     
                     
                     
                     
                     2. Description of the alternative design and arrangements: 
                     
                     
                     
                     3. Conditions of approval, if any: 
                     
                     
                     
                     4. Listing of affected SOLAS
                           chapter II-1 regulations in parts C, D and E: 
                     
                     
                     
                     
                     5. Summary of the result of the engineering analysis and basis for approval, including
                        performance criteria and design casualty scenarios: 
                     
                     
                     
                     
                     6. Test, inspection and maintenance requirements: