APPENDIX 1 - Form of Certificate for Ships operating in Polar Waters
Clasification Society 2024 - Version 9.40
Statutory Documents - IMO Publications and Documents - International Codes - Polar Code - International Code for Ships Operating In Polar Waters - APPENDIX 1 - Form of Certificate for Ships operating in Polar Waters

APPENDIX 1 - Form of Certificate for Ships operating in Polar Waters

 Form of Certificate for Ships operating in Polar Waters

POLAR SHIP CERTIFICATE

This Certificate shall be supplemented by a Record of Equipment for the Polar Ship Certificate

(Official seal)
(State)
Issued under the provisions of the
International Convention for the Safety of Life at Sea, 1974, as amended
under the authority of the Government of
(name of the State)
by ____________________________________________________________
(person or organization authorized)
 
 
Particulars of shipfootnote
Name of ship…………………………………………………………………………………
Distinctive number or letters………………………………………………………………..
Port of registry………………………………………………………………………………..
Gross tonnage………………………………………………………………………………..
IMO Numberfootnote.….........................................................................................................

THIS IS TO CERTIFY:

1 That the ship has been surveyed in accordance with the applicable safety-related provisions of the International Code for Ships Operating in Polar Waters.

2 That the surveyfootnote showed that the structure, equipment, fittings, radio station arrangements, and materials of the ship and the condition thereof are in all respects satisfactory and that the ship complies with the relevant provisions of the Code.

 Category A/B/Cfootnote ship as follows:

Ice Class and Ice Strengthened Draft Range

Ice class Maximum draft Minimum draft
Aft Fwd Aft Fwd
         
         
2.1 Ship type: tanker/passenger ship/otherfootnote
2.2 Ship restricted to operate in ice free waters/open waters/other ice conditionsfootnote
2.3 Ship intended to operate in low air temperature: Yes/Nofootnote
2.3.1 Polar Service Temperature: ……..°C/Not Applicablefootnote
2.4 Maximum expected time of rescue …….days
3 The ship was/was notfootnote subjected to an alternative design and arrangements in pursuance of regulation(s) XIV/4 of the International Convention for the Safety of Life at Sea, 1974, as amended.
4 A Document of approval of alternative design and arrangements for structure, machinery and electrical installations/fire protection/life-saving appliances and arrangementsfootnote is/is notfootnote appended to this Certificate.
5 Operational limitations
  The ship has been assigned the following limitations for operation in polar waters:
5.1 Ice conditions: ...............................................................................................
  .......................................................................................................................
5.2 Temperature: ................................................................................................
5.3 High latitudes: ...............................................................................................
This certificate is valid until. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .subject to the annual/periodical/intermediate surveys in accordance with section 1.3 of the Codefootnote
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 issuing authority, as appropriate)

 Endorsement for annual, periodical and intermediate surveysfootnote

THIS IS TO CERTIFY that, at a survey required by regulation 1.3 of the Code, the ship was found to comply with the relevant requirements of the Code.

Annual survey: Signed: …………………………………………….
  (Signature of authorized official)
  Place: …………………………………………….
  Date: …………………………………………….
  (Seal or stamp of the authority, as appropriate)
Annual/Periodical/Intermediatefootnote survey: Signed: …………………………………………….
  (Signature of authorized official)
  Place: …………………………………………….
  Date: …………………………………………….
  (Seal or stamp of the authority, as appropriate)
Annual/Periodical/Intermediatefootnote survey: Signed: …………………………………………….
  (Signature of authorized official)
  Place: …………………………………………….
  Date: …………………………………………….
  (Seal or stamp of the authority, as appropriate)
Annual survey: Signed: …………………………………………….
  (Signature of authorized official)
  Place: …………………………………………….
  Date: …………………………………………….
  (Seal or stamp of the authority, as appropriate)

 Endorsement to extend the certificate if valid for less than 5 years where regulation I/14(c) of the Convention applies footnote

The ship complies with the relevant requirements of the Convention, and this certificate shall, in accordance with regulation I/14(c) 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 I/14(d) of the Convention appliesfootnote

The ship complies with the relevant requirements of the Convention, and this certificate shall, in accordance with regulation I/14(d) 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 I/14(e) or I/14(f) of the Convention appliesfootnote

This certificate shall, in accordance with regulation I/14(e)/l/14(f)footnote of the Convention, be accepted as valid until............................

Signed: .................................................................
(Signature of authorized official)
Place: ...................................................................
Date: .....................................................................
(Seal or stamp of the authority, as appropriate)
 Endorsement for advancement of anniversary date where regulation l/14(h) of the Convention appliesfootnote
In accordance with regulation I/14(h) of the Convention, the new anniversary date is ..............
  Signed: .................................................................
  (Signature of authorized official)
  Place: ...................................................................
  Date: .....................................................................
  (Seal or stamp of the authority, as appropriate)
In accordance with regulation I/14(h) of the Convention, the new anniversary date is ..............
  Signed: .................................................................
  (Signature of authorized official)
  Place: ...................................................................
  Date: .....................................................................
  (Seal or stamp of the authority, as appropriate)

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.