Cargo sнip 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 organized authorized)

Particulars of ship*

Name of ship ……………………………………..………….

Distinctive number or letters ………………………..……….

Port of registry ……………………………………………….

Gross tonnage ………………………………………..………

Deadweight of ship (metric tons)** …………………………

IMO Number ……………………………………………..….

Type of ship***

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 conver-

sion 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 1/10 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).

_________________

* Alternatively, the particulars of the ship may be placed horizontally in boxes.

** For oil tankers, chemical tankers and gas carriers only.

*** Delete as appropriate.

3. That the last two inspections of the ship's bottom took

place on ………………..and ……………………..

4. That an Exemption Certificate has/has not* been issued.

This Certificate is valid until ……………………** subject to the annual and

intermediate surveys and inspections of the outside of the ship's bottom

in accordance with regulation 1/10 of the Convention.

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 survey required by regulation 1/10 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 authority, as appropriate)

Annual/Intermediate* survey: Signed: ………………………..…

(Signature of authorized official)

Place: …………………………….

Date: ………………………..……

(Seal or stamp of authority, as appropriate)

Annual/Intermediate* survey: Signed: ………………………..…

(Signature of authorized official)

Place: …………………………….

Date: ………………………..……

(Seal or stamp of authority, as appropriate)

Annual survey: Signed: ………………………..…

(Signature of authorized official)

Place: …………………………….

Date: ………………………..……

(Seal or stamp of authority, as appropriate)

_____________

* Delete as appropriate.

** Insert the date of expiry as specified by the Administration in accordance with regula-

tion 1/14(a) of the Convention. The day and the month of this date correspond to the

anniversary date as defined in regulation 1/2(n) of the Convention, unless amended in

accordance with regulation 1/14(h).

Annual/Intermediate survey in accordance

with regulation 1/14(h)(iii)

THIS IS TO CERTIFY that, at an annual/intermediate* survey in

accordance with regulation 1/14(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 authority, as appropriate)

Endorsement for inspection of the outside of the ship's bottom**

THIS IS TO CERTIFY that, at an inspection required by regulation 1/10

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 authority, as appropriate)

Second inspection: Signed: ………………………..…

(Signature of authorized official)

Place: …………………………….

Date: ………………………..……

(Seal or stamp of authority, as appropriate)

The ship complies with the relevant requirements of the Convention, and

this Certificate shall, in accordance with 1/14(c) of the Convention,

be accepted as valid until …………………………………………………

Signed: ………………………..………………

(Signature of authorized official)

Place: ………………………………………….

Date: …………………………………………..

(Seal or stamp of authority, as appropriate)

_______________

* Delete as appropriate.

** Provision may be made for additional inspections.