Appendix 1 - Model Form of Certificate of Fitness
Clasification Society 2024 - Version 9.40
Statutory Documents - IMO Publications and Documents - International Codes - OSV Chemical Code - Code for the Transport and Handling of Hazardous and Noxious Liquid Substances in Bulk on Offshore Support Vessels - Appendix 1 - Model Form of Certificate of Fitness

Appendix 1 - Model Form of Certificate of Fitness

CERTIFICATE OF FITNESS
(Official seal)
Issued under the provisions of the
CODE FOR THE TRANSPORT AND HANDLING OF HAZARDOUS AND NOXIOUS LIQUID SUBSTANCES IN BULK ON OFFSHORE SUPPORT VESSELS (OSV CHEMICAL CODE) (resolution [A.…(30)])
under the authority of the Government of
………………………………………………………………………………………………………
(full official designation of country)
by ……………………………………………………………………………………………………
(full designation of the competent person or organization recognized by the Administration)
Particulars of vesselfootnote  
Name of vessel .......................................................................................
Distinctive number or letters ......................................................................................
IMO numberfootnote ......................................................................................
Port of registry ......................................................................................
Gross tonnage ......................................................................................
Date on which keel was laid or on which the vessel was at a similar stage of construction or (in the case of a converted vessel) date on which conversion to offshore support vessel was commenced
……………………………
The vessel also complies fully with the following amendments to the Code:
…………………………………………………………………………………………………….
…………………………………………………………………………………………………….
The vessel is exempted from compliance with the following provisions of the Code:
…………………………………………………………………………………………………….
…………………………………………………………………………………………………….

 THIS IS TO CERTIFY:

1 That the vessel has been surveyed in accordance with the provisions of 1.4 of the Code;

2 That the survey showed that the construction and equipment of the vessel and the condition thereof are in all respects satisfactory and that the vessel complies with the relevant provisions of the Code;

3 That the vessel has been provided with a Manual in accordance with appendix 4 of Annex II of MARPOL as called for by regulation 14 of Annex II, and that the arrangements and equipment of the vessel prescribed in the Manual are in all respects satisfactory;

4 That the vessel meets the requirements for the carriage in bulk of the following products, provided that all relevant operational requirements of the Code and MARPOL Annex II are observed:

Product Conditions of carriage (tank numbers, etc.) Pollution Category
     
     
     
     
     
     
     
Continued on attachment 1, additional signed and dated sheets.footnote
Tank numbers referred to in this list are identified on attachment 2, signed and dated tank plan.

5 That, in accordance with 1.3, the provisions of the Code are modified in respect of the vessel in the following manner:

…………………………………………………………………………………………………….

6 That the vessel should be loaded:

  • .1 in accordance with the loading conditions provided in the approved loading manual, stamped and dated........................ and signed by a responsible officer of the Administration, or of an organization recognized by the Administrationfootnote;

  • .2 in accordance with the loading limitations appended to this Certificate.footnote

Where it is required to load the vessel other than in accordance with the above instruction, the necessary calculations to justify the proposed loading conditions should be communicated to the certifying Administration who may authorize in writing the adoption of the proposed loading condition.footnote

This Certificate is valid until (dd/mm/yyyy) ……………………………...…………………………footnote
subject to surveys in accordance with 1.4 of the Code.
Completion date of the survey on which this certificate is based: ..............................................
  (dd/mm/yyyy)
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)

Notes on completion of Certificate:

1 The Certificate can be issued only to vessels entitled to fly the flags of States which are both a Contracting Government to SOLAS and a Party to MARPOL.

2 Products: products listed in 1.1.9 of the Code, or which have been evaluated by the Administration in accordance with 1.1.10 of the Code should be listed. In respect of the latter "new" products, any special provisions provisionally prescribed should be noted.

3 Products: the list of products the vessel is suitable to carry should include the noxious liquid substances of category Z which are not covered by the IBC Code and should be identified as "IBC Code chapter 18 Category Z".

ENDORSEMENT FOR ANNUAL AND INTERMEDIATE SURVEYS
THIS IS TO CERTIFY that at a survey required by 1.5.2 of the IBC Code the vessel was found to comply with the relevant provisions of the Code.
Annual survey: Signed………………………………………………
  (Signature of duly authorized official)
Place……………………………………  
Date (dd/mm/yyyy)…………………………  
(Seal or stamp of the Authority, as appropriate)  
Annual/Intermediatefootnote survey: Signed………………………………………………
  (Signature of duly authorized official)
Place……………………………………  
Date (dd/mm/yyyy)…………………………  
(Seal or stamp of the Authority, as appropriate)  
Annual/Intermediatefootnote survey: Signed………………………………………………
  (Signature of duly authorized official)
Place……………………………………  
Date (dd/mm/yyyy)…………………………  
(Seal or stamp of the Authority, as appropriate)  
Annual survey: Signed………………………………………………
  (Signature of duly authorized official)
Place……………………………………  
Date (dd/mm/yyyy)…………………………  
(Seal or stamp of the Authority, as appropriate)  
ANNUAL/INTERMEDIATE SURVEY IN ACCORDANCE
WITH 1.5.6.8.3 OF THE IBC CODE
THIS IS TO CERTIFY that, at an annual/intermediatefootnote survey in accordance with 1.5.6.8.3 of the IBC Code, the vessel was found to comply with the relevant requirements of the Convention:
Signed………………………………………………  
(Signature of duly authorized official)  
Place……………………………………  
Date (dd/mm/yyyy)…………………………  
(Seal or stamp of the Authority, as appropriate)  
ENDORSEMENT TO EXTEND THE CERTIFICATE IF VALID
FOR LESS THAN 5 YEARS WHERE 1.5.6.3 OF THE IBC CODE APPLIES
The vessel complies with the relevant requirements of the Convention, and this Certificate should, in accordance with 1.5.6.3 of the IBC Code, be accepted as valid until .......................
Signed………………………………………………  
(Signature of duly authorized official)  
Place……………………………………  
Date (dd/mm/yyyy)…………………………  
(Seal or stamp of the Authority, as appropriate)  
ENDORSEMENT WHERE THE RENEWAL SURVEY HAS BEEN
COMPLETED AND 1.5.6.4 OF THE IBC CODE APPLIES
The vessel complies with the relevant requirements of the Convention, and this Certificate should, in accordance with 1.5.6.4 of the IBC Code, be accepted as valid until .......................
Annual survey: Signed………………………………………………
  (Signature of duly authorized official)
Place……………………………………  
Date (dd/mm/yyyy)…………………………  
(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 1.5.6.5 OR 1.5.6.6 OF THE IBC CODE APPLIES
This Certificate should, in accordance with 1.5.6.5/1.5.6.6footnote of the IBC Code, be accepted as valid until .......................
Signed………………………………………………  
(Signature of duly authorized official)  
Place……………………………………  
Date (dd/mm/yyyy)…………………………  
(Seal or stamp of the Authority, as appropriate)  
ENDORSEMENT FOR ADVANCEMENT OF ANNIVERSARY DATE WHERE 1.5.6.8
OF THE IBC CODE APPLIES
In accordance with 1.5.6.8 of the IBC Code, the new anniversary date is .......................
Signed………………………………………………  
(Signature of duly authorized official)  
Place……………………………………  
Date (dd/mm/yyyy)…………………………  
(Seal or stamp of the Authority, as appropriate)  
In accordance with 1.5.6.8 of the IBC Code, the new anniversary date is .......................
Signed………………………………………………  
(Signature of duly authorized official)  
Place……………………………………  
Date (dd/mm/yyyy)…………………………  
(Seal or stamp of the Authority, as appropriate)  

ATTACHMENT 1 - TO THE CERTIFICATE OF FITNESS

Continued list of products to those specified in section 4, and their conditions of carriage.

Products Conditions of carriage (tank numbers, etc.) Pollution Category
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Date ………………………… ……………………………………………………
(dd/mm/yyyy) (Signature of official issuing the Certificate
(as for Certificate) and/or seal of issuing authority)

ATTACHMENT 2 - TO THE CERTIFICATE OF FITNESS

Name of vessel: …………………………………………………………………………………………………………
Distinctive number or letters:………………………………………………………………………………………………
Date ………………………… ……………………………………………………
(dd/mm/yyyy) (Signature of official issuing the Certificate
(as for Certificate) and/or seal of issuing authority)

Copyright 2022 Clasifications Register Group Limited, International Maritime Organization, International Labour Organization or Maritime and Coastguard Agency. All rights reserved. Clasifications Register Group Limited, its affiliates and subsidiaries and their respective officers, employees or agents are, individually and collectively, referred to in this clause as 'Clasifications Register'. Clasifications Register assumes no responsibility and shall not be liable to any person for any loss, damage or expense caused by reliance on the information or advice in this document or howsoever provided, unless that person has signed a contract with the relevant Clasifications Register entity for the provision of this information or advice and in that case any responsibility or liability is exclusively on the terms and conditions set out in that contract.