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)
|