CARGO SHIP SAFETY CONSTRUCTION CERTIFICATE

(Official Seal)

Country

Issued under the provisions of the

INTERNATIONAL CONVENTION FOR THE SAFETY OF LIFE AT SEA, 1974

The                                (Name) Government certifies

I, the undersigned                                (Name) certify

That the above-mentioned ship has been duly surveyed in accordance with the provisions of Regulation 10 of Chapter I of the Convention referred to above, and that the survey showed that the condition of the hull, machinery and equipment, as defined in the above Regulation, was in all respects satisfactory and that the ship complied with the applicable requirements of Chapter II-1 and Chapter II-2 (other than that relating to fire-extinguishing appliances and fire control plans).

This certificate is issued under the authority of the Government. It will remain in force until

Issued at ............................................................... the ....................................... day of.................................................. 19.........

Here follows the seal or signature of the authority entitled to issue the certificate.

........................................................

Seal

If signed, the following paragraph is to be added:

The undersigned declares that he is duly authorized by the said Government to issue this certificate.

........................................................

Signature

Note.—It will be sufficient to indicate the year in which the keel was laid or when the ship was at a similar stage of construction except for 1952, 1965 and the year of the coming into force of the International Convention for the Safety of Life at Sea, 1974, in which cases the actual date should be given.