Cargo ship Safety radio Certificate

This Certificate shall be supplemented by a Record of Equipment

(Form R)

(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 ………………………………………..………

Sea areas in which ship is certified to operate

(regulation IV/2) …………………………………………….

IMO Number ………………………………………………..

Date on which keel was laid or ship was at a similar stage

of construction or, where applicable, date on which work

for 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 1/9 f 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 not**been issued.

___________

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

** Delete as appropriate.

This Certificate is valid until ……………………* subject to the periodical

surveys in accordance with regulation 1/9 f 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 periodical surveys

THIS IS TO CERTIFY that, at survey required by regulation 1/9 f the

Convention, the ship was found to comply with the relevant requirements

of the Convention.

Periodical survey: Signed: ………………………..…

(Signature of authorized official)

Place: …………………………….

Date: ………………………..……

(Seal or stamp of authority, as appropriate)

Periodical survey: Signed: ………………………..…

(Signature of authorized official)

Place: …………………………….

Date: ………………………..……

(Seal or stamp of authority, as appropriate)

Periodical survey: Signed: ………………………..…

(Signature of authorized official)

Place: …………………………….

Date: ………………………..……

(Seal or stamp of authority, as appropriate)

Periodical survey: Signed: ………………………..…

(Signature of authorized official)

Place: …………………………….

Date: ………………………..……

(Seal or stamp of authority, 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).