Appendix I - Form of Certificate
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Statutory Documents - IMO Publications and Documents - International Conventions - MARPOL - International Convention for the Prevention of Pollution from Ships - Annex IV of MARPOL 73/78Regulations for the Prevention of Pollution by Sewage from Ships - Appendix I - Form of Certificate

Appendix I - Form of Certificate

International Sewage Pollution Prevention Certificate
 
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, as amended, (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)
 
Particulars of shipfootnote
Name of ship.........................................................................................................................
Distinctive number or letter...................................................................................................
Port of registry......................................................................................................................
Gross tonnage......................................................................................................................
Number of persons which the ship is certified to carry........................................................
IMO Numberfootnote..........................................................................................................................
New/existing shipfootnote
Date on which keel was laid or ship was at a similar stage of construction or, where applicable, date on which work for a conversion or an alteration or modification of a major character was commenced.......................................................................................
Type of ship for the application of regulation 11.3:footnote
New/Existing passenger ship
Ship other than a passenger ship
THIS IS TO CERTIFY
1 That the ship is equipped with a sewage treatment plant/comminuter/holding tankfootnote and a discharge pipeline in compliance with regulations 9 and 10 of Annex IV of the Convention as follows:
footnote1.1 Description of the sewage treatment plant:
Type of sewage treatment plant......................................................
Name of manufacturer.....................................................................
The sewage treatment plant is certified by the Administration to meet the effluent standards as provided for in resolution MEPC.2(VI).
The sewage treatment plant is certified by the Administration to meet the effluent standards as provided for in resolution MEPC.159(55).
The sewage treatment plant is certified by the Administration to meet the effluent standards as provided for in the Guidelines on implementation of effluent standards and performance test for sewage treatment plants, adopted by resolution MEPC.227(64), as amended, including/excludingfootnote the standards of section 4.2 thereof.
 
footnote1.2 Description of comminuter:
Type of comminuter.........................................................................
Name of manufacturer.....................................................................
Standard of sewage after disinfection.............................................
   
footnote1.3 Description of holding tank:
Total capacity of the holding tank....................................................M3
Location...........................................................................................
   
1.4 A pipeline for the discharge of sewage to a reception facility, fitted with a standard shore connection
       
2 That the ship has been surveyed in accordance with regulation 4 of Annex IV of the Convention.
       
3 That the survey shows that the structure, equipment, systems, fittings, arrangements and material of the ship and the condition thereof are in all respects satisfactory and that the ship complies with the applicable requirements of Annex IV of the Convention.
       
This Certificate is valid until..................................................................................................footnote
subject to surveys in accordance with regulation 4 of Annex IV of the Convention.
       
Completion date of survey on which this Certificate is based:.....................................dd/mm/yyy
Issued at...............................................................................................................................
(Place of issue of Certificate)
       
...............................   ....................................................................
(Date of issue)   (Signature of authorized official issuing the Certificate)
       
(Seal or stamp of the authority, as appropriate)
       
       
Endorsement to extend the Certificate if valid for less than 5 years where regulation 8.3. applies
The ship complies with the relevant provisions of the Convention, and this Certificate shall, in accordance with regulation 8.3 of Annex IV of the Convention, be accepted as valid until............................................................................
Signed: .......................................................  
(signature of authorized official)
Place: .........................................................  
Date: ..........................................................  
(Seal or stamp of the authority, as appropriate)
   
Endorsement where the renewal survey has been completed and regulation 8.4 applies
The ship complies with the relevant provisions of the Convention, and this Certificate shall, in accordance with regulation 8.4 of Annex IV of the Convention, be accepted as valid until...........................................................................
Signed: .......................................................  
(signature of authorized official)
Place: .........................................................  
Date: ..........................................................  
(Seal or stamp of the authority, as appropriate)
   
Endorsement to extend the validity of the Certificate until reaching the port of survey or for a period of grace where regulation 8.5 or 8.6 applies
This certificate shall, in accordance with regulation 8.5 or 8.6footnote of Annex IV of the Convention, be accepted as valid until...........................................................................
Signed: .......................................................  
(signature of authorized official)
Place: .........................................................  
Date: ..........................................................  
(Seal or stamp of the authority, as appropriate)
Parent topic: Annex IV of MARPOL 73/78 Regulations for the Prevention of Pollution by Sewage from Ships
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