SOLAS-2012

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Appendix, Certificates, Part A <strong>SOLAS</strong> 74/78 Form of Exemption Certificate page 49/83 EXEMPTION 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 organization authorized) Particulars of ship 1 Name of ship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Distinctive number or letters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Port of registry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Gross tonnage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IMO Number 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . THIS IS TO CERTIFY: That the ship is, under the authority conferred by regulation . . . . . . . . . . . . . . . . . . . of the Convention, exempted from the requirements of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . of the Convention. Conditions, if any, on which the Exemption Certificate is granted: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Voyages, if any, for which the Exemption Certificate is granted: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Alternatively, the particulars of the ship may be placed horizontally in boxes. 2 In accordance with IMO ship identification number scheme adopted by the Organization by resolution A.600(15)
Appendix, Certificates, Part A <strong>SOLAS</strong> 74/78 page 50/83 This certificate is valid until . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . subject to the. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Certificate, to which this certificate is attached, remaining valid. 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)
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SOLAS-2012

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