Appendix 1 - Form of Certificate for Ships operating in Polar Waters
Clasification Society 2024 - Version 9.40
Statutory Documents - IMO Publications and Documents - Resolutions - Maritime Safety Committee - Resolution MSC.385(94) – International Code for Ships Operating in Polar Waters (Polar Code) – (Adopted On 21 November 2014) - Appendix 1 - Form of Certificate for Ships operating in Polar Waters

Appendix 1 - 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…………………………………………………………………………………..
Port of registry…………………………………………………………………………………
Distinctive number or letters……………………………………………………………………
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: …………………………………………….
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 appliesfootnote

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)footnoteof 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

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)

Record of Equipment for the Polar Ship Certificate -

This record shall be permanently attached to the Polar Ships Certificate

Record Of Equipment For Compliance With The International Code For Ships Operating In Polar Waters

1 Particulars of ship:

Name of ship:……………………………………………………

Distinctive number or letters:…………………………………..

 2 Record of equipment

2.1 Life-saving appliances

1 Total number of immersion suits with insulation: .........................
1.1 for crew .........................
1.2 for passengers .........................
2 Total number of thermal protective aids .........................
3 Personal and Group Survival Equipment .........................
3.1 Personal survival equipment – for number of persons .........................
3.2 Group survival equipment – for number persons .........................
3.3 Total capacity of liferafts in compliance with chapter 8 of the Polar Code .........................
3.4 Total capacity of lifeboats in compliance with chapter 8 of the Polar Code .........................
 2.2 Navigation equipment
1 Two independent echo-sounding devices or a device with two separate independent transducers .........................
2 Remotely rotatable, narrow-beam search lights controllable from the bridge or other means to visually detect ice .........................
3 Manually initiated flashing red light visible from astern (for ships involved in icebreaking operations) .........................
4 Two or more non-magnetic independent means to determine and display heading .........................
5 GNSS compass or equivalent (for ships proceeding to latitudes over 80 degrees) .........................

 2.3 Communication equipment

1 Sound signaling system mounted to face astern to indicate escort and emergency manoeuvres to following ships as described in the International Code of Signals (for ships intended to provide ice breaking escort). ………………...
2 Voice and/or data communicatons with the relevant rescue coordination centres ………………...
3 Equipment for voice communications with aircraft on 121.5 and 123.1 MHz. ………………...
4 Two-way voice and data communication with a Telemedical Assistance Service (TMAS). ………………...
5 All rescue boats and lifeboats, whenever released for evacuation, have a device (for ships certified to operate in low air temperature): ………………...
5.1 for transmitting vessel to shore alerts; ………………...
5.2 for transmitting signals for location; ………………...
5.3 for transmitting and receiving on-scene communications. ………………...
6 All other survival craft have a device: ………………...
6.1 for transmitting signals for location; and ………………...
6.2 for transmitting and receiving on-scene communications. ………………...
THIS IS TO CERTIFY that this Record is correct in all respects:
Issued at………………………………………………………………………………
  (Place of issue of the Record)
………………………………. …………………………………………………….
(Date of issue) Signature of duly authorized official issuing the Record)
(Seal or stamp of the issuing authority, as appropriate)

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