Appendix - Forms of the Document of Compliance, the Safety Management Certificate, the Interim Document of Compliance and the Interim Safety Management Certificate
Clasification Society 2024 - Version 9.40
Statutory Documents - IMO Publications and Documents - International Codes - ISM Code - International Management Code and Revised Guidelines on Implementation of the ISM Code - International Safety Management (ISM) Code – Resolution A.741(18) - Part B - Certification and Verification - Appendix - Forms of the Document of Compliance, the Safety Management Certificate, the Interim Document of Compliance and the Interim Safety Management Certificate

Appendix - Forms of the Document of Compliance, the Safety Management Certificate, the Interim Document of Compliance and the Interim Safety Management Certificate

Parent topic: Part B - Certification and Verification

Document of Compliance

DOCUMENT OF COMPLIANCE
(Official seal)   (State)
Certificate No.    
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)
Name and address of the Company ..........................................................................................................................................................................................
  ..........................................................................................................................................................................................
  (see paragraph 1.1.2 of the ISM Code)
Company identification number ...............................................................................................................................................
THIS IS TO CERTIFY THAT the safety management system of the Company has been audited and that it complies with the International Management Code for the Safe Operations of Ships and for Pollution Prevention (ISM Code) for the types of ships listed below (delete as appropriate):
   
    Passenger ship
    Passenger high-speed craft
    Cargo high-speed craft
    Bulk carrier
    Oil tanker
    Chemical tanker
    Gas Carrier
    Mobile offshore drilling unit
    Other cargo ship
     
This Document of Compliance is valid until ..........................................................., subject to periodical verification.
     
Completion date of the verification on which this certificate is based:.................................................
(dd/mm/yyyy)
     
Issued at ....................................................................  
(place of issue of the document)  
     
Date of issue .............................................................  
     
  .................................................................................................................................................
  (Signature of the duly authorized official issuing the document)
     
(Seal or stamp of issuing authority, as appropriate)
     
Certificate No.
ENDORSEMENT FOR ANNUAL VERIFICATION
THIS IS TO CERTIFY THAT, at the periodical verification in accordance with regulation IX/6.1 of the Convention and paragraph 13.4 of the ISM Code, the safety management system was found to comply with the requirements of the ISM Code.
1st ANNUAL VERIFICATION Signed: .......................................................................................
  (Signature of authorized official)
  Place: ..........................................................................................
  Date: ...........................................................................................
2nd ANNUAL VERIFICATION Signed: .......................................................................................
  (Signature of authorized official)
  Place: ..........................................................................................
  Date: ...........................................................................................
3rd ANNUAL VERIFICATION Signed: .......................................................................................
  (Signature of authorized official)
  Place: ..........................................................................................
  Date: ...........................................................................................
4th ANNUAL VERIFICATION Signed: .......................................................................................
  (Signature of authorized official)
  Place: ..........................................................................................
  Date: ...........................................................................................

Safety Management Certificate

SAFETY MANAGEMENT CERTIFICATE
(Official seal)   (State)
Certificate No.    
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)
Name of ship: ..............................................................................................................................................
Distinctive number or letters: ..............................................................................................................................................
Port of registry: ..............................................................................................................................................
Type of ship*: ..............................................................................................................................................
Gross tonnage: ..............................................................................................................................................
IMO Number: ..............................................................................................................................................
Name and address of Company: ..............................................................................................................................................
  ..............................................................................................................................................
  (see paragraph 1.1.2 of the ISM Code)
Company identification number ..............................................................................................................................................
THIS IS TO CERTIFY THAT the safety management system for the ship has been audited and that it complies with the requirements of the International Management Code for the Safe Operation of Ships and for Pollution Prevention (ISM Code), following verification that the Document of Compliance for the Company is applicable to this type of ship.
     
This Safety Management Certificate is valid until..................................................................................................................
subject to periodical verification and the Document of Compliance remaining valid.
     
Completion date of the verification on which this certificate is based ................................
(dd/mm/yyyy)
     
Issued at ...................................................................................................  
(place of issue of the document)  
     
Date of issue ................................................................................  
     
  ..............................................................................................................................................
  (Signature of the duly authorized official issuing the document)
     
(Seal or stamp of issuing authority, as appropriate)
     
* Insert the type of ship from among the following: passenger ship, passenger high-speed craft; cargo high-speed craft; bulk carrier; oil tanker; chemical tanker; gas carrier; mobile offshore drilling unit; other cargo ship.
     
Certificate No.
ENDORSEMENT FOR INTERMEDIATE VERIFICATION AND ADDITIONAL VERIFICATION (IF REQUIRED)
THIS IS TO CERTIFY THAT, at the periodical verification in accordance with regulation IX/6.1 of the Convention and paragraph 13.8 of the ISM Code, the safety management system was found to comply with the requirements of the ISM Code.
INTERMEDIATE VERIFICATION Signed: .......................................................................................
(to be completed between the second and third anniversary date) (Signature of authorized official)
    Place: ..........................................................................................
    Date: ...........................................................................................
ADDITIONAL VERIFICATION* Signed: .......................................................................................
    (Signature of authorized official)
    Place: ..........................................................................................
    Date: ...........................................................................................
ADDITIONAL VERIFICATION* Signed: .......................................................................................
    (Signature of authorized official)
    Place: ..........................................................................................
    Date: ...........................................................................................
ADDITIONAL VERIFICATION* Signed: .......................................................................................
    (Signature of authorized official)
    Place: ..........................................................................................
    Date: ...........................................................................................
* If applicable. Reference is made to paragraph 3.2.3 of the Guidelines on Implementation of the International Safety Management (ISM) Code by Administrations (resolution A.788(19)).
     
Certificate No.
ENDORSEMENT WHERE THE RENEWAL VERIFICATION HAS BEEN COMPLETED AND PART B 13.13 OF THE ISM CODE APPLIES
The ship complies with the relevant provisions of part B of the ISM Code, and the Certificate should, in accordance with part B 13.13 of the ISM Code, 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 VERIFICATION WHERE PART B 13.12 OF THE ISM CODE APPLIES OR FOR A PERIOD OF GRACE WHERE PART B 13.14 OF THE ISM CODE APPLIES
This Certificate should, in accordance with part B 13.12 or part B 13.14 of the ISM Code, be accepted as valid until ...........................................
    Signed: .......................................................................................
    (Signature of authorized official)
    Place: ..........................................................................................
    Date: ...........................................................................................
     
(Seal or stamp of the authority, as appropriate)

Interim Document of Compliance

INTERIM DOCUMENT OF COMPLIANCE
(Official seal)   (State)
Certificate No.    
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)
Name and address of the Company .............................................................................................................................................
  .............................................................................................................................................
  (see paragraph 1.1.2 of the ISM Code)
Company identification number .............................................................................................................................................
THIS IS TO CERTIFY THAT the safety management system of the Company has been recognized as meeting the objectives of paragraph 1.2.3 of the International Management Code for the Safe Operations of Ships and for Pollution Prevention (ISM Code) for the type(s) of ships listed below (delete as appropriate):
    Passenger ship
    Passenger high-speed craft
    Cargo high-speed craft
    Bulk carrier
    Oil tanker
    Chemical tanker
    Gas carrier
    Mobile offshore drilling unit
    Other cargo ship
     
This Interim Document of Compliance is valid until ...................................................................
     
Issued at .....................................................................  
(place of issue of the document)  
     
Date of issue ..............................................................  
     
  .............................................................................................................................................. (Signature of the duly authorized official issuing the document)
     
(Seal or stamp of issuing authority, as appropriate)

Interim Safety Management Certificate

INTERIM SAFETY MANAGEMENT CERTIFICATE
(Official seal)   (State)
Certificate No.    
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)
Name of ship: ..............................................................................................................................................
Distinctive number or letters: ..............................................................................................................................................
Port of registry: ..............................................................................................................................................
Type of ship*: ..............................................................................................................................................
Gross tonnage: ..............................................................................................................................................
IMO Number: ..............................................................................................................................................
Name and address of Company: ..............................................................................................................................................
  ..............................................................................................................................................
  (see paragraph 1.1.2 of the ISM Code)
Company identification number ..............................................................................................................................................
THIS IS TO CERTIFY THAT that the requirements of paragraph 1.4 of the ISM Code have been met and that the Document of Compliance / Interim Document of Compliance** of the Company are relevant to this ship.
     
This Interim Safety Management Certificate is valid until ................................................................................................................subject to the Document of Compliance / Interim Document of Compliance** remaining valid.
     
Issued at .....................................................................  
(place of issue of the document)  
     
Date of issue ..............................................................  
     
  .............................................................................................................................................. (Signature of the duly authorized official issuing the document)
     
(Seal or stamp of issuing authority, as appropriate)
Certificate No.    
 
The validity of this Interim Safety Management Certificate is extended to:........................................................................
Date of extension:....................................................................
     
  .............................................................................................................................................. (Signature of the duly authorized official extending the validity)
     
(Seal or stamp of issuing authority, as appropriate)
     
* Insert the type of ship from among the following: passenger ship, passenger high-speed craft; cargo high-speed craft; bulk carrier; oil tanker; chemical tanker; gas carrier; mobile offshore drilling unit; other cargo ship.
** Delete 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.