Appendix II

FORM OF CERTIFICATE

INTERNATIONAL OIL POLLUTION PREVENTION CERTIFICATE (1973)

(Note:  This Certificate shall be supplemented by a Record of Construction and Equipment)

Issued under the Provisions of the International Convention for the Prevention of Pollution from Ships, 1973, as modified by the Protocol of 1978 relating thereto (hereinafter referred to as "the Convention") under the authority of the Government of ................................................................... (full designation of the country)

by   ...........................................................................................................  (full   designation   of   the competent person or organization authorized under the provisions of the Convention)

Type of ship:

Oil tanker.*

Ship other than an oil tanker with cargo tanks coming under Regulation 2(2) of Annex I of the Convention*

Ship other than any of the above.*

*Delete as appropriate

THIS IS TO CERTIFY:

This  Certificate  is  valid  until  ....................................  subject  to  surveys  in  accordance  with Regulation 4 of Annex I of the Convention.

Issued at ........................................................ (Place of issue of Certificate)

..................................... 19.........

(Date of issue)

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

(Signature of duly authorized official issuing the Certificate)

(Seal or stamp of the Authority, as appropriate)

ENDORSEMENT FOR ANNUAL AND INTERMEDIATE SURVEYS

THIS IS TO CERTIFY that at a survey required by Regulation 4 of Annex I of the Convention the ship was found to comply with the relevant provisions of the Convention:

Annual survey:

Signed .....................................................

(Signature of duly authorized official)

Place .......................................................

Date ........................................................

(Seal of stamp of the Authority, as appropriate).

Annual*/Intermediate* survey:

Signed .....................................................

(Signature of duly authorized official)

Place .......................................................

Date ........................................................

(Seal of stamp of the Authority, as appropriate).

Annual*/Intermediate* survey:

Signed .....................................................

(Signature of duly authorized official)

Place .......................................................

Date ........................................................

(Seal of stamp of the Authority, as appropriate).

Annual survey:

Signed .....................................................

(Signature of duly authorized official)

Place .......................................................

Date ........................................................

(Seal of stamp of the Authority, as appropriate).

*Delete as appropriate

Form A : Supplement to the International Oil Pollution Prevention Certificate (IOPP Certificate) - Record of Construction and Equipment for Ships other than Oil Tankers

Form B : Supplement to the International Oil Pollution Prevention Certificate (IOPP Certificate) - Record of Construction and Equipment for Oil Tankers