1 Name and IMO Number of receiving
ship
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2 Port
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3 Date of commencement of
delivery
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4 Name, address, and telephone number of
marine fuel oil supplier
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5 Product name(s)
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6 Quantity in metric tons
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7 Density at 15°C
(kg/m3)footnote
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8 Sulphur content (%m/m)footnote
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9 A declaration signed and certified by
the fuel oil supplier's representative that the fuel oil supplied is in
conformity with regulation 18.3 of this Annex and that the sulphur content of
the fuel oil supplied does not exceed:
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□ the limit value given by regulation 14.1 of this Annex;
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□ the limit value given by regulation 14.4 of this Annex; or
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□ the purchaser's specified limit value
of _____ (% m/m), as completed by the fuel oil supplier's representative and on
the basis of the purchaser's notification that the fuel oil is intended to be
used:
-
.1 in combination with an equivalent means of compliance
in accordance with regulation 4 of this Annex; or
-
.2 is subject to a relevant exemption for a ship to
conduct trials for sulphur oxides emission reduction and control
technology research in accordance with regulation 3.2 of this Annex.
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The declaration shall be completed by
the fuel oil supplier's representative by marking the applicable box(es) with a
cross (x).
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